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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> --------------------------------- ------ Permit No. <br /> (Complete in Triplicate) <br /> ----------I---------------------------------------------- <br /> Date Issued �-- -- ------- <br /> This <br /> ------ <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ,` e- -- - --CENSUS TRACT S_u-4-------- <br /> JOB-t.ADDRESS/LOCATION --�b-+�7--�- -G�-���E'.'� -... ------ ` - ---- <br /> Owner's Name --- `� Phone <br /> ff .- •-- -------- ----- ------- <br /> City <br /> Contractor's Name ---- =------------------Lice se Trailer Court ----- Phone ------------------------------ <br /> Inst illation will serve: Residence partment Horse❑ Commercial ❑ I❑ , <br /> t Motel ❑Other ------------------- ----------- <br /> Number of living units:---I---_--- Number of bedrooms--------Garbage Grinder ------------ Lot Size -------I-A---------------------•-• <br /> Water Supply: Public System and name --_--_--_-_ Private ®_ <br /> Character of soil to a depth of 3 feet: Sand' Silt ElClctiy:❑�",Pett E] Sandy Loam ❑ Clay Loam <br /> .� Hardpan ❑ Adobe'❑ Fill Material ----- ------ If yes,type ------------------------ <br /> t k lI i <br /> (Pl'otl,plahr howing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse aside.) <br /> NEW;iNSTALLATION: (No septic tank or seepelcie pit permitted if public sewer is availablelwithin 200 feet,) Q <br /> 1 PACKAGE TREATMENT { ] SEPTIC TANK [ Size------------------------------------------------ Liquid Depth -------_i------- ----- N <br /> Capacity � --- -- TYPif"`"&111.1 aterial ----- No. Compartments -_ �_•._-_-_. <br /> --_ <br /> Distance to nearest: Weil --.--.--- _ -_-_-.Foundation _ ( ..._____ Prop. Line _ 1.�'�_-___---- <br /> r <br />" LEACHING LINE [I�No. of Lines ----.0------------ Length of each line- ----------- Total Length :- - - _..':-------- <br /> 'D' Box ZdAd--- Type Filter Mated Depth Filt` Material �l� -------- --- -----•------ <br /> I •P <br />} <br /> Dista `ce`10-riearestFoundation—Z9 Property Line ---- ..---------- <br /> t SEEPAGE PIT [ ] Dept --------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ]; No <br /> j Water, Tab'Ie Depth ---------------------------------------I-----r-_.Rock Size --._-----------------`---�----- <br /> Fndati� --------------- ' o <br /> `� 'inl�eDistance tonearest: Well ----------- <br /> REPAIR/ADDITION(Prev. Sanitation Pei�mit <br /> �'. <br /> # -------- <br /> .------------------------ <br /> ----------- Date --------------------------- <br /> Se - -----) <br /> I } 4 <br /> Septic Tank (Specify Requirements} -------- --------------------------------------------------------------------- --- ------------'- ----------1-------------- <br /> p p „ter <br /> 1 . <br /> Disposal Field (Specify Requirements) ----� -------------------------------------------------------------------- - <br /> -------- ----------------------------- ---------------------- ---------------------- ---------- -------- <br /> ------------ <br /> ----------- -------------------- - - ---------------- --=---------- ---------- ----------------------------------------------------- ------- <br /> (Draw existing and required addition o reverse on side) { <br /> ,�. g q � 1 <br /> I hereby certify that I have plepared this application and that the work will be�,done in accordance with Sari Joaquin <br /> Counity Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local`:Health District. Homeowner oricen- <br /> F sedagents signature certifies the following: # <br /> t "I certify that in the erfarn <br /> ork'"for which this permit is iss ed, I shall nor employ any person in such manner <br /> as to become s ec o Wansation laws of California." �r <br /> Signed ---�---------------------------------- Owner <br /> - - ---- --- -- ----- Y <br /> BY ---- --------------------------- <br /> Tltle -------------- --------------- ---------- --------- - --------- --(If other than <br /> FOR DEPARTMENT USE ONLY I <br /> I DATE <br /> r APPLICATION ACCEPTED 6Y - _:: ' <br /> BUILDINGPERMIT ISSUED --------------------------------- -----------------------------------------------------------------------DATE -------------•--------------- <br /> ADDITIONALCOMMENTS ----------------;-------------------------------------- ------•-------------------------------------------------- --------------- ---------------•----------- <br /> ----- -- -�-------------------------------------------------------------------------------- <br /> ---------------------------------------------------------- <br /> ------- - a <br /> I -- --r------ r� <br /> ------------------- <br /> ----------- ---------------------- - .. <br /> P Y Date - -1 q'� . <br /> ----------- ---------- --------- -------------------------------------- <br /> ----- -------- <br /> Final Inspection b -T ------------ ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t E. H.- 9 .. '1-`68 Rev. 5M <br />