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d 15OR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ....._.._...` . ...................... (Complete in Triplicate? Permit No. .._.... <br /> -115.............. 7 S:._..... <br /> �—�`� - • Date issued _.�`�:� 7S ' <br />............................. - This Permit Expires 1 Y <br /> ....--- --.._. 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 .. 1CT1..-�' . ... .....................CENSUS TRACT .................... <br /> � .._ <br /> .. ..1:rt_ .�... :_. : . <br /> Owner's Name ------ ------------- Phone <br /> Address ......... .....::..: .. City <br /> ----- ••---------- •----• --......... . <br /> t <br /> Contract Name - .. ........-"-:.........................................License # - _..... 'Phone ..... °... <br /> on will serve: Residence�Apartment House-C] Commercial ❑Troiler Court ;❑ <br /> Number of livingunits:.... .,.,.,,. Number )bedrooms :._._.____..Garbo e <br /> 3 g ,Grinder Lot Size .._ ...._��`"-............... ... <br /> I <br /> Water Supply: Public System and name ......_... - --------------=------=----Private <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan [❑ Adobe C❑ Fill Material ---- If If yes, type --------- ----------•- <br /> (Plot plan, showing size`of lot, location of system in relation to wells, buildings, etc must be.placed on reverse. sial.( 0 i <br /> NEW INSTALLATION: (No septic tank or.seepage pit permitted if puHic sewer is available within 200 feet) <br /> PACKAGE TREATMENT [ ) SEPTIC TANK[ ] Size --------------------- Liquid Depth .-•.--.-_------ <br /> Capacity cs.��+ t C? _ No: Comport <br /> Typments a!� <br /> e(�. Ma enol <br /> i <br /> Distance to nearest: Well --��C?.... ---------------.--Foundation ....a7`.'......... .... Prop: Line --__!.& <br /> LEACHING LINE j No. of bries _... :. . .... length of each line . .... ;...... Total Length __-gko....:.._....i_. <br /> D' Box ..� , T' e Fifter "h�iaterialr.De the Filter' ... ....... i <br /> .. •I - f Foundation /� <br /> t Y0 p ria) <br /> .. err ate �­­­1111.•-----�-- ' <br /> Distance tb nearest: Wel! (xJ._ I . .. .....:. Property Line <br /> SEEPAGE PIT { ]: Depth: Diameter ------,-------•--- Number :..._.__ Rock Filled Yes 0 No <br /> Water_Table Depth ...........;.-.Rock Size ....................... <br /> Distance to nearest: Well ----------- __-_---Foundation Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...:............'. Date ........... ._.-_._ ._-._-___- <br /> Septic Tank (Specify Requirements) <br /> F Disposal Field (Specify Requirements) .....-- ... <br /> ..--•---------------- ------ ----------- --------------------------------- <br /> ----_--:------------------- <br /> (Draw existing and required addition on reverse side) k <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Saes Joaquln <br /> County Ordinances, State Laws, and Rules 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 Com ensation laws of California." . <br /> Signed ------ Owner 1 <br /> By .._. <br /> I <br /> ---.- --.... ............... Title . .... , <br /> (If other than ownneror)) <br /> FOR DEPARTMENT USE ONLY <br /> TIACPTSD -......... <br /> .. ............. <br /> BUILDINGAPPLICATION <br /> PERMITISSUED . ----------- ------------------------------------------ •--- ------ .. _..... DATE .................................... . <br /> . <br /> ADDITIONAL COMMENTS ............ <br /> ......__.-...-------- ------------------------- ----------------------- --------- -•------ ...... ---..... ------------------ --....._...... ...................... ...................-------------- I <br /> --------------------------- ----------------------------....._ ..... -•--.,-..--.. ------------ ............._.......------------------------ <br /> ------------------------ ---=------ -----....-------------_...-------�----------- . ........:.--•----........... <br /> . 1l.� ... <br /> Final Inspection by. ... .. . ........' ........._....._- .....-- •-----......--------------......---- --•---........................._Date ....... .'ill-T ... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />