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FOR OFFICE USE. � <br /> APPLICATION FOR SANITATION PERARIT ? _�7/ <br /> ._-.--_ ---•-•............................... Permit No. ..••••-....----•••- <br /> (Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued ..CP.'��..-3. <br /> 1 <br /> Application is hereby made to the San Joaquin Local Health District for a permit 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: j <br /> JOB ADDRESS/LOCATION ..1...1.. -••-.-,-p�U�-S_-----...�V,� .....CENSUS TRACT <br /> f Owner's Name ------ ............Phone <br /> Address ........ ........ ------ 4,,.�-- ... City <br /> �� <br /> Contractor's Name ._ �` " . _._._.License # � ��.... Phone .......... .........f <br /> Installation will serve: Residence= Apartment House j] Commercial ❑Trailer Court <br /> tel ❑ .................................... .... i <br /> Number of living units:---._._..- Numberoof bedrt Other <br /> E Garbage Gri d r Lot Size . .� �� �If? <br /> ntU 4 <br /> Water Supply: Public System and name .._ _. .Ltd ,J_ ....................................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ _ Silt❑ Ci y Peat❑ Sandy Loam 0 Clay loam <br /> Hardpan ❑ Adobe Fill Material �l��.. If yes,type............................. <br /> (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> S <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,j <br /> PACKAGE TREATMENT [ ] SEPTIC TANK .._. .. i......_._.Liquid Depth .�/i�{� ........... . <br /> Capacity I T e 1�. x Material 'No. Compartments ... ........ <br /> once to nearest.• Well ..Foundation .:�................ Prop. Line . <br /> at`:.�:...... pp r............ .� <br /> LEACHING LINE No, of Lines ------ .......... Length of each line._es,J_dsl....... Total Length .� Q................. <br /> 'D' BoxZd.. Type Filter Material :..... <br /> .. ... ....Depth Filter Material ...._/ .... <br /> F <br /> Distance o nearest: Weil ...., ............ Foundation '.'"_....._1:.__....... Property Line J..:. ............... <br /> SEEPAGE PIT [yam Depth ..s .........# aX�eter ...... Number .___.._ _ ........... Rock Filled Yes [�o Q <br /> P � <br /> r Water Table Depth . = ------------------ Rock Size ..� ?' <br /> Mance to nearest: Well _... '..-..i ...........Foundation .''.......° Prop. Line ......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# . Date ..... ................ ) <br /> h <br /> Septic Tank (Specify Requirements] F �i <br /> Disposal Field (Specify Requirements) --------------•-- ................................ •-----_-------------- .........................................:-------•----- ti <br /> ••---------- ------------------------ - . .----------------------------------------------------------------------------------------.......------------------......----•--•-•-•---- <br /> (Draw existing and required addition on reverse side) <br /> 1 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. Home owner or liven. <br /> sed agents signature certifies the following: <br /> "l certify that in the performance of the work for which this permit is issued, I shall not employ any person in "such manner <br /> i <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ....-... - Owner <br /> -- ...... �itie _. .._.- c-cL/ <br /> if er than owner)" <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .._ .: -• - ..... ....................................... ..................... DATE ©.V)...���...--------- <br /> BUILDING PERMIT ISSUED --•• --------......................DATE . .......... <br /> ADDITIONALCOMMENTS ------------------ .................................................-.............................................................:-------- ............... <br /> --•---------••-•.......................•--••...................--•-_---••-•_- ._. ............................ --•-..._._.._...........----....---•--........._..-_--_•-•-----•----...•--- <br /> ...............•.......................... ,. •--- ......------. -----,•-•--•---.....--------------------------------•-_-------•----...-- ............................................ <br /> --------------------------- _. ...-•- ••- <br /> Final Inspection by ...Date _ ��_-~ � ...... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 24 1-'68 Rev. 5M � 7/72 3 M <br />