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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) <br /> Permit No. ---------------------- <br /> _ <br /> -- - <br /> ---------- -------------------------------- p �-—-- ` <br /> Date Issued ------- -- -��--•-- - <br /> - . <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 <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ' <br /> i { <br /> JOB ADDRESS/LOCATION . - __�-E-� -- :- }' s�177 CENSUS TRACT <br /> Owner's Name FDDf y ` -------------Phone ----- <br /> Address .__.-------- City ----- ---------------------------------------------------------------•------ <br /> ------------------------- <br /> F: <br /> Contractor's Name r93--c� ---------------------------------------- License # _`^' Phone <br /> Installation will serve: Residence [U partment House❑ Commercial :❑Trailer Court i❑ <br /> Number of living units--------_.._ Numberofbedrooms ---- _---Garbage Grinder '__ Lot Size ------------A--------- <br /> i <br /> Water Supply: Public System and name ------------------------------------ ------------- - ----------------•-----------------•----•--_____---------------------Private C-1a Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe'Ql"Fill Material ------------ If yes,type ---_______----------------- <br /> I <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 isavailablewithin 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK"[ ]� Size______l- ____-_-------- Liquid Depth ____ ?----- ----- <br /> Capacity _-� �" - Type - - 5�?>� _ Material__�_t��-Y' '�[_K'_ No. Compartments ---- ._-------------� <br /> fi ---Foundation ---- --- --------- Prop. Line _ /J ------------- <br /> LEACHING <br /> -------•-� <br /> Distance to nearest: Well ------��r�_ ________-__-_- �� -- -� <br /> LEACHING LINE [ ] No. of Lines -------:) Length of each line.___9 ----------------- Total Length :_5-2 ------------- <br /> L,�n _ <br /> 'D' Box . _-'-`�---- Type Filter Material Depth Filter Material ------ -----------------•........ <br /> ;Fe ----•-� <br /> Distance to nearest. Well __ / '__ Foundation ----- --------------- <br /> _ __-�:.___......_-� <br /> SEEPAGE PIT [ ] Depth ________________ ___ Diameter ---------------- Number _.--___-------------------- Rock Filled Yes C] No <br /> WaterTable Depth ------------------------------------------------------ -------Rock Size ------------------------- <br /> kDistance to nearest: Well ----------------------------------------Foundation ---- --------------- Prop. Line ------_-_--------_--� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------.-------------•------------) <br /> i <br /> Septic Tank (Specify Requirements) -------- -------- --- ------------ ---------..__,..--------------------------- <br /> Disposal Field (Specify Requirements) --------- ------------------------- ----------------------------- --------------- w. <br /> x , -------•------ -----------------------------------------•------- <br /> ----------------------------------{Draw existing and required ad----------------------------------------------------------------------------------------------. <br /> ------------------------ <br /> dition on reverse si e) <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. 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, 1 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 /> [If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> 9 <br /> APPLICATION ACCEPTED BY -------- ------------------------------- - r----- ?i- - ---- ---G' DATE ---G-�/7- �. ---------- <br /> ---------------------- <br /> PERMIT ISSUED ------------------------------ --------- -------DATE ------------------------- <br /> ----------- <br /> ADDITIONAL COMMENTS ------------------------ ----------------------y -------------------------------------------------- ----------------- <br /> - --------------------------------------- <br /> ----------------------------------------------------------------------------------------------------- <br /> ------------------------------ ---------------------------------- - ----------------------------- <br /> ----------------- ------------------------------------------------------------------------------------------------------------- <br /> - --- --- <br /> Final Inspection b --------------------------------------------- ------aHISTRICT <br /> ��t -------.Date _-4'-'.1 --"1------------------------ <br /> SAN JOAQUIN LOCAL HEAL <br /> L E. H. 9 1-'68 Rev. 5M <br />