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FOR OFFICE USE: <br /> 1 APPLICATION FOR SANITATION PERMIT _ <br /> .. Per <br /> No. . _ .... <br /> c �S <br /> �.. �\ (Complete in Triplicate) <br />............. ---------...'_......------- I....... <br /> - Date Issued ...�..._...... <br /> ........................................................ This Permit Expires t Year From Dot*Issued <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 /> JOB ADDRESS/LOCATION ....34�.,3- -.N.4•..... -.r.... ......................................CENSUS TRACT ....... ................. <br /> Owner's Name ---------•--•......................................... ........Phone <br /> Address .>. -•--_... f .... _....g.......•.....................................•--- <br /> ..-'.............................. '-• ------........ •..._.... <br /> _ sty <br /> Contractor's Name __ -_---• �� ��• �r License f# 1,Jr7-,.- 3.. Phone .y'7', ................ <br /> �s <br /> Installation will serve: Residence jj�Apartment House Commerclal oTrailer Court 0 <br /> AMotel ❑Other ............................................ r <br /> Number of living units.!: Number of bedrooms ..A-_.__Garbage Grinder .. d... Lot Size ----•••--•-: <br /> Water Supply: Pu Kir-SX9mngnd name ...... .....Private ❑ i <br /> Character"of soil to a depth of 3 feet: ;Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam {1 Clay Loam ❑ <br /> Hardpan Q Adobe I@ 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;#ank or seepage pit .permitted if public sewer.is available within 200 feet,) ) <br /> PACKAGE TREATMENT i[ ]/SEPTIC-TANK Size........ <br /> � .. .... Liquid Depth _. S'�i�..............(jJ <br /> - Gapaci __._...---• --___-._ Material � � 'No. Compartments ..... -. <br /> .... Type ..... <br /> Distance.to nearest: Well -77777=................... ..,�.�:.�........ Prop. Line ..�~----- <br /> LEACHING LINE No. of Lines ---_--- -------- Length of each line..-•-- fG,�_.r......... Total Length ...il. .�`...---..... m' <br /> D' Box ,4f/40.. Type filter Material ..,I-Q(V'.qDepth .Filter Material ... ........ ....... 001 <br /> Distance to nearest: Well _'�....__ Foundation ......L .......... Property <br /> Line '..-.� ••--••••••• -t"I <br /> SEEPAGE PIT � Depth :_._ _ _.... Diameter ..{�.�:-1, Number ........L...........:..: Rock Filled Yes � No Q <br /> I � -. � <br /> t Wr <br /> Water Table Depth .....�(?l�._.._...---•---•--------•--•-•--stock Size ...1 �2.--r-r`............... ' <br /> Distance tonearest: Well ............................. ,l..........Foundation . 0...._...... Prop. Line -_— <br /> f � , <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...........•------------------_ ---------- Date ..................................) <br />` Septic Tank (Specify Requirements).----------'--•--••-------•.................._-............--------•------------•--•----•------...---._....._..._,.........._....---........... <br /> Disposal Field (Specify Requiremeitnts) -------•-----------------------------------------•-•............................... --------------------------------- ......_.._....:.. <br /> --------------------------------`--------........................_-.---------------------•------------.-....------------..........,---------------- <br /> 1 <br /> --------------------------------------------- <br /> ..--.--------------------..-----------------•-•--------__.._.....-•--------------->----.-..-------.-.---_...-..-•-------................._.. <br /> (Draw existing and required addition on.reverse side) <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. Horne 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 /> . <br /> _.- Title - - " ------ - <br /> By ... --- <br /> jif other than per) <br /> r , r FOR-DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY 1C: 6XN . --. DATE .. ��. . <br /> BUILDING PERMIT ISSUED --------- _. ............................••-----..............---DATE ..--_----- ... <br /> ADDITIONAL COMMENTS - == �a1rt.•• -•-•-----•_-. �=.........-- -'----.... -----•--•--_---..-.-... <br /> - -- <br /> u .. � -•---- ....---- <br /> '— 1 <br /> ...-•---....._....-•----••-•-- ••............. ................. •---------. 1---- <br /> - <br /> finalInspection by: _. .............................. <br /> Final .... -4�. .......... <br /> EH 13 2h 1-68 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />