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FOR OFFICI�USE: APPLICATION FOR SANITATION 'PERMIT <br /> Permit <br /> (Complete in Triplicate)•' <br /> ............................. Date issued <br /> ... <br /> .................... .............:...... <br /> This Permit Expires I Year from Date issued <br /> ............. <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: <br /> '7D6 3 sH 7............... <br /> JOB ADDRESS/LOCATION ... .. ._ d• - t u5 g.�...................CENSUS TRACT _-..__-•-- <br /> �. r .4 -.. - _-...._ ........................ Phone . ....... <br /> Owner's Name r <br /> Address ....... ----. City . ----.. .......................................... .... <br /> .License # - <br /> , `f" 3 Phone <br /> - s ?.' .... .._ <br /> Contractor's Name ..�`C..,.. .. F? y <br /> Installation will serve: Residence [Apartment House 0 Commercial ❑Trailer Court .❑ <br /> Motel ❑Other - ------ ----------------------------------- <br /> Number of living units:_. Number of be .."T ---Garbage Grinder ...__ .._.. Lot Size .--..---- ---•-• ..... <br /> Water Supply: Public System and name . ... ..... . ........ Private C] <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat[I Sandy loam C1 Clay loam ❑ <br /> Hardpan [ 'j Adobe ❑ Fill Material .---.-._.--- 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK Size..... 40 .......... ...... ... . liquid Depth . ��.........--••.. <br /> Material.-.� �•No. Compartments .......-_....----.... <br /> Capacity j Type - --.'...---.....? <br /> Distance to nearest: Well b ...................Foundation . ......... Prop. Line .-- --....-_.--...- <br /> LEACHING LINE No. of Lines . -3 ... . length of each line ... .... Total Length ................ <br /> f <br /> 'D' Box Type Filter Material ....Depth Filter Material .-__._ $.-+.___._.. .................. 0 <br /> Distance to nearest: Well ------- Foundation Foundation IQ-r-�_.--._ Property Line ....- W <br /> SEEPAGE PIT [ Depth Diameter ..�..*--- Number ...* _ ...... Rock Filled Yes r] No ❑ <br /> rT <br /> Water Table Depth ---- Rock Size .... ......... -­....... ..... 71 <br /> Distance to nearest: Well .....(0.e; .................... -..__lp'....... Prop. Line --. ............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------- • ---- ----------..._ Date ----------------------------------) <br /> Septic Tank (Specify Requirements) ............ ....... .. ................... •-••------------- •........................---------------------....0 <br /> Disposal Field (Specify Requirements) ..-..------_------- .. ... ....................... ....•---...at <br /> ......... •. . ........... .. . ......... . ..----... --------•__-1...... ..._.. '......_..�---�-... .L� <br /> ........ -- --------------- --------------------- <br /> DO <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 licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of 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 Compensation laws of California." <br /> Signed .... . ..... Owner <br /> By .... <br /> �...._.- . . .. ............... <br /> (If oter than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. ��. . _.... DATE ...��'... - .7ti�z............... <br /> BUILDING PERMIT ISSUED ...... . ...... . ... ....... <br /> ._. ...DATE _ . ----......--...-._.. <br /> ADDITIONAL COMMENTS ---- ---------- ---- ----------------•----...---------•....-------- ------ ----- .............I--------- <br /> ..-.... <br /> --------- ------- • -----........_..___.-/.-�-�i.T....aft----f/-/­_.Z-/9.J...... .........._.--------------.............. ...•--------....---...................................... <br /> -•------------- --------------------...............-------------------------------._................ <br /> Final Inspection by: -.--• . Date .-"- `- + <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 1+VO-- <br /> 7172 3,L4c u 13 241_'hst IR..- 5M -- a <br />