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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT {{// <br /> Permit No. .. .T"3 <br /> ........ ...... ........ (Complete in Triplicate) _ <br /> _........ i Date Issued <br /> _ This Permit Expires 1 Year From Date Issued <br /> Application b toll is hereby made II 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 /> i d <br /> -y� CENSUS TRACT <br /> JOB ADDRESS/LOCA N .��. `7 _.... ✓(.' . _._...:A.._..... _ <br /> _.. RI,. .._..... .................................... <br /> .---••-•••...................:.: Phone <br /> Owner's Name f•••• _ <br /> Address City .........I— <br /> One ........................... , <br /> ► _ license # .AF/--�'� Ph <br /> Contractor's Name .__. •°- -- • ---•----• •-•. .............. .. <br /> In'stailation will serve: Residence Apartment House Commercial ❑Trailer Court 0 <br /> N,. ...<. <br /> Motel C]Other ........... ................ <br /> Number of living-units------- Number of bedrooms ............Garbage Grinder ............ Lot Size ------------------------I............... <br /> nd name ...--�-�--•-.----=-•--••---................................................... <br /> -••---....-•-----•--••---___..Private <br /> Water Supply: Public System,� [7 <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑, Clay C] Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan C] Adobe fl Fill Material .......... If yes,type ...................... <br /> f. system in relation to wells, buildings, etc. must be placed on reverse side. <br /> (Plot plan, showing size of,lot, location o y V <br /> NEW INSTALLATION: (No septic tank or see ge pit permitted if. ublic sewer is available within 20 feet,) <br /> . 1 i / ' // <br /> Li Liquid De th _.T................... <br /> PACKAGE TREATMENT [ ] T F <br /> SEPTIC TANK i Size.Y a?..x ••••--_.K .... q p <br /> • rr Ob -L......_.._ Material...... No. Compartments .... -•••••••••-• ,�` <br /> Capacity l.c�.._.- 7ype �. i � � <br /> - i; ,.�...,.r ._ �. a � .Foundation ..1�....--------•• Prop. tine . <br /> ............ <br /> Distance"to ne est: Well .-.--•• .........- <br /> ff ..._..._._. Length of each line._ _----- Total Length .. <br /> I LEACHING LINE ( No.��lof Lines _..._ g ---_ - <br /> D' Box Type Filter Material ..__._5- -Depth—Filter Material ----.._r-• - <br /> iM o!.... Foundation ......119 .1-----•--• Property Line .. <br /> Distance to nearest: We Ef _..._.,�_. Fou <br /> ;il / Rock Filled Yes No Q <br /> SEEPAGE PIT [ Depth �.-•••••• Diameter .. .��.•--- Number ..._... -_ . <br /> --- ��M 1� <br /> Water Table Depth .. ___----•........Rock Size ... -�. -• <br /> S' <br /> ... <br /> Distance to nearest: Well ..-....... -----•••.... =•Foundation ..._l...f?.-......_ Prop. !no ...•----••-- •- <br /> REPAIR/ADDITION Prev. Sanitation Permit�# <br /> . Date <br /> __. <br /> Septic Tank (Specify Requirements) .............. ............._.__. ----•• ---•-....__...._--•.......---........---.......... <br /> --..__-----............ <br /> I .__....--•••---- -•-•---•---•------•.............. <br /> Disposal Field (Specify Requirements .................. <br /> ......................... ----------------•-.......----- <br /> .......I............................. <br /> ----..................°---------- ................I------I............ ------------_-- <br /> ----- ------------­I ---------------- --------- <br /> ......................••----•-_.... .-. <br /> ------ -• . <br /> (Draw existing and required addition on reverse side) - <br /> I hereby certify that I have <br /> 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. ome Howner or liten- <br /> sed agents signature certifies the following: M <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 /> fas to become subject to Workman's Compensation laws of California." <br /> Signed `' I . Owner <br /> Title <br /> (If other than'owner) <br /> FOR DEPARTMENT USE ONLY <br /> „F. <br /> ..... .......... DATE ...cS~-..c '" . <br /> APPLICATION ACCEPTED BY .. _ DATE <br /> BUILDING PERMIT ISSUED)- ..................:. ................... ---•:.:- ........I......... <br /> ADDITIONAL <br /> --.....I.---•• -- <br /> ADDITIONAL COMMENTS: _.. . . ...........•-•---.._......---• ..... <br /> wi. ...••---.......••..---••..................:..................•....... :.°..._.....-----••••--.........-- <br /> i,N.................... .............---•.......-----•--••--- •----•--••----•........---•--..._-•-•• ----- - -....-.__... <br /> •. <br /> . ----•---• � ,,� Date _ ..... <br /> Final Inspection by: <br /> SAN JOAQUIN- LOCAL HEALTH DISTRICT <br /> I R 7172 3 L%1 <br /> .. Z � 2L► � ice o.... KAA — - <br />