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FOR OFFICE USE: <br /> 10310 APPLICATION FOR-.SANITATION PERMIT �- <br /> --- ------- Permit No.// �lJ/ <br /> _ (Complete in Triplicate) <br /> ---------- <br /> - Date [slued 7/_. <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 /> JOB ADDRESS/LOCATION �r"e ZSyjll_(cl---��� -i` fir` �� f C CN9US TRACT -------------------------- <br /> Owner's Name -- .� -t4x to -t -f JA---------- -.��� � ���f�Phone <br /> Address --------- ------ `-�----���y-��------�--- -------------------. City --- -/"�-� ---- ------------------.................. <br /> Name - _ g.,_-lo_ � ----- - License # -`�?- -��---- Phone --------------­---- <br /> Installation <br /> -^�2-6 <br /> Installation will serve: Residence [Apartment House'❑ Commercial ❑Trailer Court <br /> Motel ❑Other -------------------------------------------- <br /> Number <br /> -------------------------- ------ <br /> Number of living units:--- Number of bedrooms ---- -----Garbage Grinder Lot Size _ - - - lf -Wit.-------- <br /> Water Supply: Public System and name .-------------------------------------------------------------------------------------------------------------Privat�,Lv <br /> Character of soil to a depth of 3 feet: Sand'u- Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ <br /> Hardpan ❑ 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'[ a ;; Size----`, ------------------C--- --- Liquid Depth ---!!�•------------ <br /> Capacity L&O------- TYpe F- `C=`� Material_�- �zrti'No. Compartments _77�--------------- <br /> Distance to nearest: Well ___----------------Foundation -------------- Prop. Line -_--_-_--.__._- j <br /> LEACHING LINE [ No. of Lines �j--_-.--__ ---- Lengthiof each line.-- �J. - Total Length _Z_l-p-------------- 1 <br /> / e� <br /> 'D' BoJto <br /> ._ Type Filter Mafierial ���_--__Depth Filter Material ___/X-------------------------------- <br /> Distannearest: Well ----- - ------ Foundation /)--------------------- Property Line - _-_-___-...._- <br /> SEEPAGE PIT [ ] Depth --------------------- Diameter :--------------- Number --------- ------------------ Rock Filled Yes ❑ No 0 <br /> Water Table Depth -----------------+--------1----------------• -Rock Size -------------------------------- ' <br /> Distance to nearest: Well; --------------------Foundation -------------------- Prop. Line ----..----------.----- Y` i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------- bate ---------------------------------- <br /> Septic <br /> --_-_--_-----__-_-.---------_-_--Se tic Tank (Specify Requirements) ---------------------------------------------------------------- -------------------------------------------------- `J <br /> Disposal Field (Specify Requirements) ---------------------------------- ------------------------------------------ -------------------------------------------------------- <br /> ------------ ti <br /> ------------------------------------------ -------------------- ---- ----------------------------------- -- <br /> --------------- ------------' ---------------- ----------------------- <br /> { ----------- ---------------------------- <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. Homeowner or licen I . <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 - r ° Owner, <br /> $y Title --- <br /> k --------------------------- <br /> 4 <br /> j �� <br /> (If other thawo _ Y <br /> FOR DEP TMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------------- DATE DATE 7 <br /> BUILDING PERMIT ISSUED ----------t-----------------------------------------------------------------------------------------------DAT E -..---------------------------------------- <br /> ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------------------------I----- ------------=---------------I----------- <br /> ------------------------------------------------- ---------------------------------------------- <br /> ----------------------------------------------------- ----- -- -- - --------- <br /> Final Inspection by: --------------------------------�-------- vb_t4-------------------------------------------------- ---Date --------- t <br /> .SAN JOAQU11v LOCAL -HEALTH DISTRICT <br /> L/.. <br /> -/E. H. 9• 1-'b8 Rev. 5M <br />