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FOR OFFICE USE: 2 <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. __7.. ............. <br /> -------------------- ------------------------------------ <br /> _________________________________________________________ This Permit Expires 1 Year From Date 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/LOCAfIO/N __ _____ ---------------------dENWS TRACT ______•---- <br /> Owner's Name ------- -----------V ,16 ---------------- --_-- ----. - --- -----_Phone <br /> Address -------------- fl:?---- . ------------------------------------------------- City ---------------------------------------------------------------------------- <br /> Contractor's Name ------ /Nnr ------------------------------------Li:ense # Phone - <br /> Installation will serve; Residence ❑Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other ------------------------ _---------------- <br /> Number of living units:----- Number of bedrooms 3.......Garbage Grinder ------------ Lot Size,_-_______•__-_______----___--__--------. <br /> Water Supply: Public$ystem and name - •.-Private [� <br /> Character of soil to a Oepth of 3 feet: Scrrrd -VrEj ",tiny-❑ -`ftcit❑ Sandy Loam ❑ /Clay,Loam ;❑ <br /> Hardpan ❑ Adobe'❑• Fill Material i----------- If yes,type ----------•----------------- (� <br /> (Plot plan, showing ize of lot, location of system in relation '`to wells, buildings, etc. must be placed on reverse side.) -r <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> d <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size-_'-`-----­------------ -------------------- Liquid Depth -___________--_-.--_,____. <br /> Capacity -------------------- Type --------------------- Material. No. Compartments _ .-..------...--_--- <br /> Distance to nearest: Well _____________ _______________%.... vndation ---------------------- Prop. Line _ _----__.----_•_-..- <br /> LEACHING LINE [ ] No. of lines ------------------------ Length of each -line ----------------------- Total Length --------- .................. <br /> 'D' Box ------------ Type Filter Material __________________ pth Filter Material .................... ----------------------- <br /> Distance to nearest: Well ______________________- Foundati nt ------------------------ Property Line ........................ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ___k_,_''_ R_____ Rock Filled Yes ❑ No 0 <br /> Water Table Depth ------------------------------------------------Rock Size --------- ------ <br /> Distance to nearest: Well ________________________________________Foundation -----If- ........... Prop. Line ...................... <br /> REPAIR/ADDITION(P v. Sanitation Permi#* ------- --------------------- Date ---_.f ......... ---------------- <br /> Septic <br /> -•_____•---_Septic Tank (Specif Requirements) --------------------------- ----------------------------- ------------------------------- <br /> Disposal Field (Sp�cify Requirements) ----- ------------------------ <br /> y` 3' � --------------------- <br /> ----- - -- ---- -------- -------- -------- ------ -- - 9 ---- - --------- •--_------------------------------------i ----- •------------_-- ----------- <br /> (Djawexistin and.required addition.-on.reverse side) <br /> 1 hereby certify that have prepared this application and;that the work will be done in accordance with San Joaquin <br /> County Ordinances, t ate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature ertifies the following: <br /> "1 certify that in the erformance of the work fon which this, permit is issued, I shall not employ any person in such manner <br /> as to become subject o Workman's Compensatioin laws of California." ' <br /> Signed _� -- -- -- -ap- <br /> Pw------------ ---- ---- --------- Owner <br /> By ------- ------- ---------- - ----------------------------------- --------------------------------- Title ---- <br /> ----- -------------------------- <br /> --------------------------------- <br /> (If other han owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------- Q - -------- --------------------------------------------- DATE --- —2/-------------------- - <br /> BUILDING PERMIT ISSUED ----- ---------------------------------------------------=-----------------------------------------------DATE ------------- ------------------ <br /> ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------- ----------------------- - --=----------__ --_-------- <br /> ----------------•----------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------•_...... <br /> ------------------------------- ---------- - - - <br /> ---------------------------------------------- -- ----------------- - --- ---- --- <br /> Final Inspection by: ----------------------------------------------------------------------------------------Date __ +'/G-?/------------ ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />