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' FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> (Complete in Triplicate) Permit No..-7 _-_-._ <br /> p p ' <br /> Date Issued--- <br /> Application <br /> --•••---- - ---- ---- ---- - ------.--.-- This Permit Expires 1 Year From Date Issued ' <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in complianSc�e-with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION.- -------��1 _.its � , �/ .' CENSUS TRACT. - <br /> ��. y _._._ .,s <br /> Owner's ._ +fir <br /> ----- Phone ! <br /> s <br /> Address-----------------+ ------------- ---- - <br /> • sb - City ��� - ----------------------- ziP <br /> Contractor's Name___-.._ .C,!_-{ ----- ------------License <br /> _ --- ---- --- - i�' �:---..Phone-�_������--• <br /> Installation will serve-. . ResidenceQ Apartment House❑ Commercial El Trailer Court ❑ <br /> Motel ❑ c6her___.__..___ <br /> Number of living units: m <br /> units.----.-/---- bedrooms---43 <br /> __Garbage Grinder------------Lot Size--____-_. --z. _- -- ------------ <br /> F <br /> Water Supply: Public System and name--- ____________ ___ <br /> --t-------------------------- ------------Y---------- -------- <br /> --------------------- <br /> ---------------Private <br /> - <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay E] Peat Peat Sand Loam ❑ Clay <br /> Loam <br /> Hardpan ❑ Adobe ❑ Fill Material_---------If yes, type---------------- <br /> ---------------- <br /> (Plot <br /> ______________ _--__ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l <br /> PACKAGE TREATMENT [ j SEPTIC TANK Size <br /> ------------------------------------- <br /> --------Liquid Depth--------_------------------ <br /> Capacity-----------_--------Type--- <br /> __---------------Capacity----------_--------Type--- -------------------Material--------------------------No. Compartments.--- <br /> ------------------ <br /> Distance Distance to nearest: Well--------------- <br /> ----------------------------Foundation--------------------------Prop. Line--------`--------- <br /> LEACHING LINE [ j No, of Lines- ________________-- Length of each line------------------------------Total Length.______-.-________ <br /> ------------------ <br /> [ 'D' Box-----------.Type Filter Material-_----____---------Depth Filter Material---_________-_.___._ <br /> ---- ---------------` <br /> Distance to nearest: Well---------------------------_Foundation----------------------------Property Line------- - ----- -- - ----- - - "� <br /> SEEPAGE PIT [ j Depth----------------Diameter_-------------------Number <br /> --------------------------_ - Rock Filled Yes❑ No ❑ <br /> ' Water Table Depth.______________________- Rock Sof <br /> Distancento nearest:'Well: _ _- ------- ---- --- ---_.__._,_ Foundation'-.-......._----------Prop. Line-------------------------- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#______________ --_____--____-____.Date -------------------------- <br /> - -------------- <br /> Septic Tank (Specify Requirements)---i--------------_-_------------- <br /> -------------------- <br /> ----------------- - <br /> Disposal Field (Specify Requirements) =---- --U ±�-- .--------- - -5,4 G-l� <br /> .v <br /> ----- ------ -•-- , , <br /> ------- --- -- -------------------------------------- <br /> w i <br /> -----------1--------------------------------- <br /> -.; ;-- ----------- ------------------------------------ <br /> — =; =------------------- <br /> (Draw e*,istin�'and,requirecl "addition on reverse side) <br /> I hereby certify that I have prepdred is application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, ad' Rules nd Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: r t'� T <br /> "I certify that in the performance of a work for which this permit is issued I shall not employ an <br /> to become subject/o Workman's Ca p p Y Y person in such manner as <br /> ' pensat�on Paws of California. , <br /> Signed - � <br /> r <br /> ,,Owner <br /> BY ----------------- ------------ ---------------..Title----------- ---- <br /> F { _ I _ __ <br /> (If other than o ner) <br /> i <br /> t FOR DEPARTMENT USE ONLY 3 <br /> APPLICATION ACCEPTED BY__ ---- <br /> --- „ .__-._. . <br /> - ------- -- DA E. 7-= - --- ------- <br /> DIVISION OF LAND NUMBER ------------------ <br /> --- ---- ----- ------ ---------- - - --------- ---------------------------------- - - DATE------- -------------------- <br /> ADDITIONAL }---- <br /> COMMENTS_.____..___._ _._ <br /> ---- --------- <br /> - -- ..-. _.. _.�. ..-...__ _.. .._� __ .� --I-------- ---- -- _ <br /> _.Y <br /> r _ - -- <br /> - --------------------------------------- - <br /> ----- <br /> ---------------------- <br /> ------------------------------------------ <br /> ---------------------------- -- <br /> -------------------- <br /> - ----------------- - -------- ----------------- - <br /> Final Inspection by: -------------------- <br /> ______.___Date._ ____ . __.`— __ <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F85 21677 REV, 7176 3M <br />