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- -- FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ....... . ............................ --••-••-• p h Permit No. 7 <br /> (Complete in Triplicate) <br /> ..................................................... �����. �, W.10(0( � ��751,6N <br /> This Permit Expii� - r From Date issued 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 Ordin nce No. 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LOCATI N ... . <br /> ... CENSUS TRACT ........................ <br />` Ph <br /> Owner's Name _...--_. .. _ �^ ......... .... G ..._.. one ......................-.•--......... <br /> AddressG G.-h..._ -- - ----- ........._. -------- ............... <br /> Contractor's Name ---------------...-- --------------------------------------_.,.License # --------- ----------•--- Phone .... --------------- ---_ - <br /> Installation will serve: Residence[]Apartment House❑ Commercial❑Trailer Court ❑ <br /> Motel d Other -----------------------------•------------- <br /> Number of living units:-------•---- Number of bedrooms ------------Garbage Grinder ------------ Lot Size ----•........•---------------••=......... <br /> •-- <br /> Water Supply: Public System and name ........ ........ ..........................._..-----------................Private ❑ <br /> Character of soil to o depth of 3 feet: Sand'❑ Silto Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ <br /> Hardpan ❑ Adobes' 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: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC.TANK f ) Size_..... 2.Q0- Liquid Depth .......................... <br /> Capacity ------------------•- Type .._._........... --. Material------------•---------- No. Compartments ---_-----_---_-- <br /> r11 � <br /> Distance to nearest: Well _.. ..Z................Foundation ......... Prop. Line ----------- <br /> LEACHING LINE [ ] No. of Lines ... 7........... Length of each line.___:_....._..... Total Length67. <br /> 'D' Box ..../------ Type Filter Material kcw_...Depth .Filter Material ........................�.--..�,.... <br /> .--•. <br /> Distance to nearest: Well _,l(JrO.__...._..._ <br /> foundation .... <br /> __.._.__ Property Line .�/[.'...`I .:.... <br /> SEEPAGE PIT [ ] Depth -------------------- Diametteer ................ Number ............................ Rock Filled Yes ❑ No ❑ <br /> Water Table Depth .........l = -- ..................... <br /> ..... .Rock Size - ----- <br /> Distance to nearest: Well ----------------------------------------Foundation .................... Prop. Line ..-•-----.--------..-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................ ----------- pate .........•...............---------) <br /> E Septic Tank (Specify Requirements) ----------------------------------------------------------.....................................................I..........----•-- <br /> Disposal Field (Specify Requirements) <br /> •--••--------------------------•--------------------------------------------------------- --------------------------------------- ----------- -••-----------•-- .------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with Son 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 "I certify that in the performance of the work for which this permit js issued, l shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------------------- -- ----------------------------------- ..................... Owner <br /> Title -------- ------------------ - <br /> &I, ot-her than owner) <br /> F94 DEPAR MI N7 SE ONLY <br /> APPLICATION ACCEPTED BY ---- ....................... DATE _._..-... <br /> BUILDING PERMIT ISSUED ./•----------------- ----- ----- DATE ------ <br /> .._..... <br /> ADDITIONAL COMMENTS .- .� - .--- ---•------------•---------------------------------------...._..._.-:-•------ -------- <br /> ------------------------"..__...---------•-----------._.....-----•-•------------------h'-------------------------`------------ --------- ------------_------- ----------------------_ ......... <br /> ---------------------------------------•----------------------------------------------------.-------------.._•__.-----------------------------------------._..-.................................---------- <br /> ---------------------______-..__.------------._ __..___ _---_-.---__ ______ ... _. _ ______.__._..-- ..__._._.__.._.__...__.____.______.... <br /> final inspection by: .. ..... Date ... `� .............. <br /> EH 13 2!t 1-68 Rev. 5MSAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />