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.FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> k •... ............................................... Permit No. <br /> (Complete In Triplicate) .:............. <br /> ... This Permit Expires I Year From Dat*Issued Dote Issued �Z.-Z......... <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 compflanie with County Ordinance-No. 549 and existing Rules and Regulations: <br /> 4 'a_ r-. R <br /> } JOB ADDRESS/LOCATION.......1-1.)- ----..-f l �-.___-- <br /> _ . .. . ...........................•CENSUS TRACT .................... <br /> Owner's Name .......... ��,�Tll/d -Y .---•-- -......:-•--• •..... ...........I——..._...... ._... Phone .���'.--�7��•��`�..__.... <br /> Address .......... ...... . <br /> ......____..._. <br /> -•-- � -- �-- --...... city........... ... ..... ..... ........:�- <br /> Contractor's Name ---------_---_ _---•-- ....� .� .......License tl` ---.. <br /> �'il/l:r�_-• �-- ....... ��'�_.:�'�:�_ Phone . --- -..... ------- <br /> Installation will serve: ` Residence[ Apartment House fl Commercial,oTrailer Court- 0 <br /> Motel ❑Other ' <br /> Number of living units•..._:_ Number of bedrooms Garbage Grinder ............ Lot Size <br /> - v.. ��...._ _!�___._....... <br /> Water Supply: Public System and name y i <br /> Y� <br /> p ------------------•-------........._.._`... ..-----.....__._.�:...._.._....-------------- <br /> ..................Private ❑ <br /> Character of soil'to a de th of 3 feet: Sand.b Silt.o Clay,,❑� Peat❑ t Sandy Loom 0 Clay Loam <br /> Hardpan O Adobe 0 Fill Material • if•yes, < <br /> type ............... ............ <br /> (plot plan, showing size of lot, location of system in gelation to"wells, buildings;'etc: must be planed on reverse side.j <br /> NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) fr <br /> PACKAGE TREATMENT ( SEPTIC TANK ' <br /> •.� » ----- --•--'--...--�----=- Liquid.Depth ..-��... .......... ... � <br /> Capacity }1 -:-_ -_ Type -- --��--•---.-_ Material.. .� c... No. Compartments ._ -: <br /> Distance to nearest: Well __....................._.............Foundation ..._. ... Prop: Line .... . <br /> t <br /> LEACHING LINE No. of Lines ........ Length of each line----___.. �.: .`..."Total Length G�, <br /> 'D' Box Type Filter Materia{ ..IISX,, " <br /> ...------... ..Depth Filter Material .i-.��----------------.............................. <br /> Z <br /> ��.. <br /> 'Of to eet: Well --_ .-.- __ • Foundation ------fProperty Line: �_. . . <br /> ........... <br /> SEEPAGE P#T Depth -- �' - - - - � Number ............. YRockFilled Yes <br /> ' <br /> No ❑ � <br /> Water Table Depth ----------------------••........................Rock Size -, .r.l._ . <br /> Distance to nearest: Well --------..............•------- <br /> ..........Foundation ..............-..... Prop. Line ...................... <br /> v <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ... -,S. ------------- nate�::�;���•- .'t�•___- �`� <br /> Septic Tank (Specify Requirements( --------- ------- !` <br /> ..............•-- ........ <br /> Y , . <br /> Disposal Field (Specify Requirements) ............................................................... •4. _:- <br /> .....-. <br /> --•......................•----------•••••--.....---------- --- <br /> �y M <br /> - =-----------------------I..........................(Draw existing and.required oddition on reJerse side)" <br /> E 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 Mules 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, 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 /> k BY -- --.--- -- - - - n -- Title ..... 11 ' <br /> (Vo -e ha owned <br /> --- -------- ---------------------------- <br /> ---- <br /> F R DEPARTMENT USE ONLY A ' <br /> APPLICATION ACCEPTED BY -------- - ...... _- DATE .--..-... . -•---...--- <br /> -------- <br /> ------------•---••---------••-- <br />{ BUILDING PERMIT ISSUED ------------ -•--- -- • • -•- ------- _DATE DATE -...---... -----. ...- .-.-- --- <br /> iADDITIONAL COMMENTS .. - -.-------- •-•--...-. --------------..............--. <br /> f ------ ------------ •--•-•--------------•------- <br /> -------------------------------------------- ........ -•-- ------.Date .... <br /> Final Inspection by; ------------ - <br /> EH 13 <br /> 24 fes' SAN JOAQUIN LOCAL HEALTH DISTRICT 8I74 3m <br /> C <br />