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FOR OFFICE USE: FOR OFFICE USE: <br /> . APPLICATION FOR SANITATION PERMIT <br /> .......................... <br /> � ` <br /> (Complete in Triplicate) Permit No..... g.":._..� <br /> ................I I!. . ....._......_.......... <br /> ...... -----••.F ................... ........... This Perntif Expires 1 Year From Dow Issued Date Issued._~1.."�7 <br /> Appl1n is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> Thisft-14ation is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADpRESS/LC ATIZ _--/-/..q... �- 6./......... . .. ...... .........................CENSUS TRACT..... ......... ......•---•-- <br /> Owner's Na . . ...... ............ ........................... ...........Phone .......... <br /> Address ,, f . .......:.:. -----City---.................. ......................zip.. ......-- -••------------- <br /> ---•..... <br /> ....... <br /> Contractor's Nar�► <br /> me .........License #... ���/J!. .....Phone........... .................... <br /> �rj . . <br /> Installation will serve: ResidenceA Apartment House E] Commercial ❑ Trailer Court ❑ <br /> M tel ❑ Other------------ ---------- -------•--. .......... <br /> Number of living units:... /.....,::".Number of bedrooms..' '-----Garbage Grinder............Lot Size...�z�.�G .. <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 0 Fill Material....... ...-If yes, type................................ <br /> s <br /> (Plot plan, showing size of lot, location of system in relation to wells,.buildings,etc. must be placed on reverse side.) S <br /> NEW INSTALLATION: (No`septic tank or seepage pit permitted if public sewer is ovdiloble within 204 feet,) <br /> PACKAGE TREATMENT ( j SEPTIC TANK [ ) Size._FX.16A.1.0..............................Liquid Depth ..y.................. <br /> Ca aciCompartments <br /> ...gid.. <br /> p ty.�:j�.6.-...---TYPe-.,��----- ------Material.�r-..2,......--•....No, Compartments....y�„ .- <br /> Distdnce to ea�rest: Well.._/. . ........ ... ... .Fanddtionf <br /> P .............Prop. Line. ..........,��"j� <br /> LEACHING LINE ( ] No. of Lines....... ....... "..".Length of each,line.......�lj" ................ otal Length/ 70.................... <br /> D' Box_ .- T pe Filter MateriaL..... / Depth Filter Mdterial.., ..... .,�.,. .............. <br /> Distance to nearest: Well... f'J......_-.�Foundctfiicn:.:. :..Pro ine.,: ... . . _ <br /> �'."`. <br /> SEEPAGE PIT ( ] Depth. - - Diameter..", Number...._. Rack Filled' . No <br /> o� . .......---- ❑ <br /> Water Table Depth..........................................................Rock Size.__/... '` <br /> Distance to nearest: Well................:..........................Foundation............ . .........'Prop. Line. ....- <br /> Data ! <br /> REPAIR/ADDITION (Prev. Sanitation Permit#..........................................-----.-. . .........----_--_-- ,.-..•-_- -,-i...__.....j <br /> Septic Tank (Specify Requirements)-------------- ........ ..... . ..... L• • .........--- ..... ••. ..,- <br /> t <br /> Disposal Field (Specify Requirements)). .......... . ... 1 <br /> . . . <br /> ....•--•-••--•••••••----••--••---...-••---•----•....................................................•------------••-••--•••••...._....... .... ..... -•------------------------------•- <br /> (Draw existing and required addition on reverse.side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in ae�"ance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> 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 as <br /> to become subject to Workman's Comnansation laws of California." <br /> Sig <br /> ned....-..- : ........ ..Owner <br /> By........: . .._ ...... . . �.. ;..Title................. ........................... <br /> (If other than owner) <br /> FOR DEP**TMIENTIUSE ONLY <br /> P Pi <br /> APPLICATION ACCEPTED BY_ ....- ..............•-••---•---•------......DATE... .. •-- ^-..... - <br /> DIVISION OF LAND NUMBER----•----------.. ----------------------------------------DATE. <br /> . ......_.. <br /> ADDITIONALCOMMENTS............................. ............................................................. <br /> ------------------•--------- ....................................... ............................................................................................................................................ <br /> ................................................... ................... •. <br /> ........................................................... ...... .. •7LOXCA <br /> . •---_.... ...Final Inspecfion b Date ...... ..... - ---------- <br /> Y' •-•...EH 13 24F8s 2 ; tiEV.7/7�SAN JOAQ IN HEA H DISTRICT <br />