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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> f <br /> Permit No. -.7-7--- <br /> (Complete in Triplicate) <br /> This Permit Expires 1 Year From bate Issued 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 ... 5 .. CENSUS TRACT ... <br /> Owner's Name ............ ........ .. .................... .'Phone ya.7;0- .... <br /> Address .----•-..- �- ........ .. .._.. ................ City _.. . . ........................................... <br /> Contractor's Name �..._. ._. ..License # .?-y :. Phone <br /> .............................. <br /> installation will serve: Residence []Apartment House Q Commercial ❑Trailer Court"C] <br /> Motel ❑Other ----•....................................... �- T <br /> Number of living units-------1...... Number of bedrooms ---3-----Garbage Grinder ... _ Lot Size ....�7.r-'�..A.zs .......... <br /> Water Supply: Pub1 is System y tem and-name_. •------•----... ........---_------------------------------------------------ _�_�i. '�"�-�!T_ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Q <br /> i w <br /> Hardpan ❑" Adobe Fill Material............. If yes,type _........................... <br /> p 4 � <br /> (Plot plan, showing size of lot, location of system 'in relation to wells buildings,a #c. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tancc r seepage pit permittedrif-publk sewer is available within 200 feet,J l <br /> PACKAGE TREATMENT .[ ] SEPTIC TANK I ] Size-...........,--------.__.•....----.----------- Liquid Depth ..........................` } <br /> ...... Type —::::.--.__ <br /> Capacity •---......... YP •-----•-----•---'--•• ---•_.... No, Compartments ......................1" <br /> .. - ''.Foundation .....----•------ <br /> ?Distance to nearest: Well ........................... ._...� ^; _____ Prop. Line ......................� <br /> LEACHING LINE [ ] �No. of Lines ........................ Length of each line.........I.................... Total Length ............................ <br /> 'D' Boz ............ Type Filter Material ....................Depth Filter Material ............................................. <br /> Distance to nearest: Well ........................ Foundation ....--...__ ............ Property Line ............. .......... <br /> V <br /> SEEPAGE PIT O Depth Diameter . Number _.-'.--------................ Rock Filled Yes [] No {] <br /> Water Table Depth ................................Rock Size `e! . `... <br /> Distance to nearest: Well ----------------_- ...................Foundation ..........._........ Prop. Line ...................... <br /> REPAIR/ADDITION(Preva Sanitation.Permit�f# Date_____________________ J <br /> Requirements) ._ ...Septic Tank (Specify Requirements) .....................•----•••--- - - ....................................... <br /> Disposal Field (Specify - <br /> u1/ ' <br /> a -- ' l ----------------------------------------------- <br /> ro-.- - --i�g- �--that the-work <br /> -------------------------- ........• -- *.. f -------------------------. <br /> � �;y a;.w, Ibraw existing and re aired'addition on reverse side) � <br /> 1 hereby certify that I have prepared this application and will be done in accordance with San Joaquin i <br /> County Ordinances, State Laws, and Rules and'IRegulations of the San .Fa�aquin Local Health District. Home owner or [icon- <br /> -.� <br /> sed agents signature certifies the following: _ <br /> "I certify that in the performance of the work for-which tliis pekmitjs 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 r <br /> T418 __ <br /> ��^.,7� <br /> By ....... -•--------------•---- ........ ­-­----------------- <br /> (if o er a owner) <br /> AOR- P RTMENT USE' ONLY <br /> i <br /> APPLICATION ACCEPTED BY'....', ------- =-- -= -- ................... DATE ....... ...... .._ <br /> BUILDING PERMIT ISSUED ...... . . . <br /> ----- -- -- ----- -- ---------- - --••-•----........._------------------------•--------DATE .......... .....- .... .........._..... <br /> ADDI O 0 ENT5 .._ . -- ........ • • •. •.. ._ ...... } ------- .......................... ..... <br /> :_ f.. --------------.........................."...-------- ---- -- •- <br /> --------------- ................ ..•-•,----•---.... .................. -------------- ...... .... <br /> FinalInspection by ............ ... . ....... ... .. . . .. ......------...................-------•-•-....-•------•--._......Date ....... � <br /> JOA LOCAL HEALTH DISTRICT <br /> 41 <br /> F. 14.13 24 1-'ea Rev- 5M . t 7,172 31A � <br />