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FO <br /> OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> (CompWe-in Triplicate) Permit <br /> -- ------------------------------------------------------ <br /> ------ ---------------------L------------------------- This Permit Expires 1 Year From Date Issued Date Issued .---------------- --- <br /> IL <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 /> JOB ADDRESSAOCATION --:L'`------ ------------ ---CENSUS TRACT --------------•--- ------ <br /> Owner's Name --------- <br /> ----------------- ---------- Phone ------------------------------- <br /> Addr6ss -----------1-4"e- ----------------- city ------ <br /> ----------------------- ------- <br /> Contractor's Name __/ * `.License # -_14�_ _,Phone i"_ ------- -------- <br /> Installation will se :Residence'serve::, .9-6artment House,E] Commercial:E]Trailer Court ;,0 <br /> Motel El Other ----- ------ <br /> Number of living units:.... ----iNumbeN <br /> r.-of bedrooms -----Garbage,Grinder 14ovt�9 Lot Size <br /> __________- <br /> Water Supply, Public System and name --------------------------- <br /> ------------------------------------------------------- ----- ---- -- ---- <br /> Character of soil to a depth of 3 fe'et: SandF] Silt 0 Clay El Peat E] Sandy Loam 0 Clay Loam F1 <br /> ,Hardpan E] Adobe-E:] 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 /> Z . <br /> NEW INSTALLATION: (No septic tankrdi�seepcige pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANkf Size------------------------------------------------ Liquid Dept`=-------------_----•,_-_-• <br /> ' K� <br /> Capacity <br /> ---------------- Type -------------------- Material------------------- No. Compartment's ------------------ <br /> Distance to nearest. Well ------------------------------------ <br /> Foundation ---------------------- Prop. Line ----- ---------------- <br /> 9 ne--- -------------- --- Length-;' ---- ----------------- 7- <br /> LEACHING LINE No. of Lines ---------------------.'A6n_ih7'Wf_e6C-41i_ Total <br /> 'D' Box ------------ Type Filter Material --------------------Depth th Filter Material -------------------- -------------- ........ <br /> i Distance to nearest:' Well ---1_____: -------- --- Foundation ------------------------ Property 'Line ------------- <br /> SEEPAGE PIT Depth -------------------- Diameter - ----- <br /> Number ---------------------------- Rock Filled Yes E] 'No 0 <br /> I <br /> "W�ter_Table, Depth -------------:----------------------I-------------Rock Size -------------------------------- <br /> sC- �_Qistance,to nearest: Well -------------------------------------',--Foundation --------------- ---- Prop. Line ---------------..----- <br /> REPAIR/ADDITION(Prev. S6nitation ermit#;-------•-----------------------=`---------- Date ----------------------------------) <br /> Septic Tank (Specify:Reqyireme*nits)------------ ------- ------- --- <br /> ---------- <br /> D is <br /> p9sa ie <br /> I Field (Specify Recl6trements),,N,9_9 Z <br /> -------------------- <br /> - <br /> - <br /> - ---------------- <br /> -------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I '-JDrdwexisting and required addition on reverse side) <br /> I hereby certify that I have prepared this application-"and that, the work'will be dome in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations'of the Son 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 /> ens--i <br /> .on'to become subject to Workman's Com`pLans-_l*n'ICwS of California."- <br /> Signed -----------------t------ --- ------- ------------------ <br /> --- ---------------------------- Owner <br /> By ------------------------ - - -- <br /> ------ -- Title <br /> ---- -- - --- ---------- ------------- - ---- <br /> (If dt an owner) <br /> FOR,DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- ---- -3 <br /> -------- 7----------------------------- ---------- --------------- DATE ------------ --- <br /> BUILDING PERMIT ISSUED ---------- - -- r <br /> --------- --------- �-----—---------------------------------------------DATE --------------------------------------- <br /> ADDITIONAL.COMMENTS --------------------------------- <br /> I <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - ---------------------------- <br /> -------- ---------------------- ------------- ------------------------------------------- <br /> ----------------------------------------------------------------------- <br /> ------------------- <br /> ------------------------------------ <br /> -- - - ---- -------- ------------------------ -- ----- ------------------------------------------------------------- <br /> Final Inspection by: ---- --1 -------------------------------------------------------------------------------Date ----- 46- 47- <br /> SAN JOAQUIN LOCAL` HEALTH DISTRICT <br /> E. H. 9 T- <br />