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FOR OIC&USE: <br /> -. .. _ <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------- <br /> - ----------------------- Permit No: -_-- <br /> (Complete in Triplicate) <br /> --------=---------------------------------------------- >ti r.. ..-Date Issued <br /> Thif-Permit Expires 1 Year From Date Issued <br /> Application is hereby made to ihe;Son.Joaquin Lo al Health Di Dict-,,for a permit to construct and install the work herein <br /> described. This application is # ad'e�in compliance with County Or$inane`No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION . - 0, 4 --------------------------CENSUS TRACT -------------:--�._.":--- <br /> ] r <br /> Owner's Name -------- ----- 9--r� �. Phone.����'����`/--- <br /> 3 �Address ------ ---- City ------ `= --=---T i a`4---------�------------------ <br /> Contractor's Name - <br /> �J--------- - - ------ - I -------License # �-Phone <br /> Installation will serve: esR ldence (Pariment House❑ Commercial []Trailer Court ❑ <br /> �. ❑ rns --�---._..Gar�a'------------------- <br /> Number of livingunits------------- Number bedrooer <br /> } `ge Grinder --- Lot Size ------- l----- <br /> Water Supply: Public System and name%------------------)----- -------- ------l ---- = - =Pr_ir at <br /> Character of soil to a depth of 3 feet== Sand' a heat Sand Loam �Cla 'Loam -..� <br /> p Hardpan ❑ Adobe ❑ Fill Material ----_------ If yes, type -------------�R -------� <br /> (Plot plan, showing size of lot, I cation of system in-relation tol%vells, buildings, etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septictink\or seep a pit permitted if public sewer is available within 200 feet,) £ <br /> 1= r s I <br /> 12rNK --``�----------- -------��,� Liquid Depth -- S <br /> PACKAGE TREATMENT { ] SEPTIC.TANK f'"" Size_ <br /> Ca acct <br /> p, Y - Type Material4V__€ C�-. No. Compartments ---°'3"" <br /> .i � I l 'r.f _- _ f L f <br /> Distance to; nearest: Well ..-f ---_-_-per- LN I <br /> -r_-_-----_Foundation ----- <br /> Pro Line --__��_ ._-.... <br /> f - - - p• <br /> �l:v+.��.'��.'..-� L iIJ 1 .....mac•:�.b i l� <br /> LEACHING LINE No. of Lines _- `�`.-_____;__ Leni of each line-.. _ ---- Total Length <br /> { + - ----------- <br /> 'D' Box J_------ Type Filter Material _ lJ __/__ th Filter Material _- --------------------------------- <br /> Distance to nearest: Well�)VIO------------ Foundation - ------------- Property Line -_ ------------ n <br /> SEEPAGE PIT [ ] Depth ---------------`---- Diameter ----------------/Number ----- .-. Rock Filled Yes ❑ .-No C1 9 <br /> Water Table Depth ---------€-- ---- ...Rock Size -- :!------------------------- <br /> Distance to nearest: Well --------------------Foundation S---------------- Prop. Line ---------_-_-_.------- r 1 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _--_-_--.---- ....:..:.....:.____._--__Date__-_-----_-___-__•-_--_____._-__-_-] <br /> I ------------------------•--'-`:-t---- f <br /> Septic Tank (Specify Requirements} --;..�-.---- --------------------------------------- ti -------------•-•--------------------------- r <br /> Disposal Field (Specify Requirements) ---------------------------------------------------------.- f----------- ----- <br /> - <br /> - --------------------------- ----------- <br /> (Draw existing and required addition on reverse, ide) - <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.--Nome owner or licen- <br /> sed agents signature certifies the following: j f <br /> "I certify that in the performance Wf the work For which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensationnlaws of California." <br /> Signed • Owner <br /> ` --------- ------------------f - _ <br /> -i------------------------- Title ----------------- ----------------------------------•------------- <br /> If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- ► --------------- -------------------------------------------- --------------- DATE <br /> BUILD.LNG_.P.ERMIT-ISSU.ED------•.--------•--_-- _ ---------------------------DAT-E.......................... .------------ <br /> ADDITIONAL COMMENTS-ti -- <br /> �.. i th <br /> -------------------- ---- ----- --- -- ------ --•- - -----f 't _=--------- ------ .__ �` •< <br /> ____--.-.-------------------------- .rte—«..«...../-- <br /> - -. <br /> ---- ------- ------------- - ---�-_- ._ -_J—4--.--- -- "___.--------.----------_--_---------.--------------_---_------ .__- ---------- <br /> --------------- <br /> ------------------ - - - __ - --- _---------------------_----.---------------------------.--__-._ <br /> Final Inspe�#�`- --- --- -• ---_ ------ - Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />