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FOR OFFICE USE: �y <br /> APPLICATION FOR SANITATION PERMIT �/ (Q <br />..............._-..-.........._.-._....... Permit No. .�.f..:.�a..._ <br /> (Complete in Triplicate) <br />,,,-•„--_--,,,-, „1_ ,,,0,._..,,,.._.,,, This Permit Expires 1 YeorFrom batelssued <br /> 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 ._.5201. '5h1ey Ln.................... . ................ .....CENSUS TRACT .......................... <br /> Owner's Nome _Jim...F.orx-P_st.....................•---.................................,......................_...........---Phone ..4.64....96.4.9............. <br /> AddressS ...... City S tkn. <br /> . <br /> Contractor's Name . :ckaxd.'.S_S.ep-tl-e--- ank.............................License # - _-2.68951__- Phone A61-?Qj:$........ <br /> Installation will serve: Residence KJ Apartment House-❑ Commercial (]Trailer Court a <br /> Motel ❑Other _. _ -------- ...._................... <br /> Number of living units:__. ..2 Number of bedrooms ....5......Garbage Grinder Lot Size..._._... ...aQ e................... <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 0 <br /> Hardpan ❑ Adobe ® Fill Materia{ ..... .-... 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> Nf PACKAGE TREATMENT I ] SEPTIC TANK j J Size....-_.20'X5'X6X6' . Liquid Depth �................. <br /> Capacity 2000 __ Type -_s.q., .._ Material_..concrete No. Compartments ...... ...... <br /> Distance to nearest: Well 13.0-'­_11----.............Foundation .-l0.!..-. ....... Prop. Line .........3D'..... <br /> LEACHING LINE (x] No. of Lines 3 . Length of each line . ..:__ 6.0.'. Total Length ..._........1Q�t.....� <br /> 'D' Box .1 Type Filter Material ...__2ll..:. p 1.9 ............._De Depth Filter Material ..__....... . .. ............... <br /> Distance to nearest: Well ....... Foundation 2.0-r........ Property line ...5................... <br /> .j <br /> SEEPAGE PIT I Ix Depth 25'._ Diameter ..4.81V....... Number . 3 ............ Rock Filled Yes L! No t <br /> Water Table Depth .. -----9Q_t.....................Rock Size ......2 ......-............ j <br /> { Distance to nearest: Well .....1.50.1..........................Foundation .....20.'._...... Prop. line .......Cj1....... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........ ____..........._._........ Date ..................................) <br /> Septic Tank (Specify Requirements) 20.0Q..i a1..._........ ....._...--------••---....................... ...........................................-._.-.......... <br /> Disposal Field (Specify Requirements) .... 6.0.'..-Leach--Li-n-es,-- total-___.180.'.. _ 1 ........--------- ...... <br /> ........ 0Y <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 accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licon- <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 Compensation laws of California.” <br /> Signed . _ ----- --... -- -•--- --- .. Owner <br /> By . �-�� Title .Contractor <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE .Z zo <br /> BUILDING PERMIT ISSUED -. - - DATE <br /> ADDITIONALCOMMENTS .. •....... ....................... ...................... ....... ........... . ...... -............. -•--..._....... ......... <br /> .......... ....... ------- ------ . . - -- - _ .._......_.,.._.._....................----I......... <br /> t <br /> ----------------•-- ------- ) -.- . ---- •--•- -••---_...... ................................... <br /> Final Inspection by: ... ..... . . ...................... ............ .... .... Date ............................................ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 241-'68 Rev. 5M <br />