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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. ... <br /> ............... <br /> 4 <br /> ICoe+p�In Triplicate) <br /> ...... ... <br /> . �.... <br /> ar <br /> ......................................................... This Permit Expires i YeFrom Date Issued Date Issued .:�.:.13:. <br /> Application is hereby made to the San Jo quip local Health District for a permit to construct and install the work herein <br /> described. This applic tion Is made in,emplionce with County dinance No. 549 and ex�Istlng Rules and Regulations <br /> �t ' <br /> JOB ADDRESS/LOC o ION..k-.... i .`-...... �..'.G . . ..: ..:.".....CENSUS TRACT ............. <br /> Owner's Name ---- � �%- -ti`-5. . ,_i. _........���... 4 �..�......... .......... Phone .................................... <br /> Address ----- _ ..?.........z. A. A..".1..........................City ..................................... ................ .. . ... .I....../ <br /> Contractor's Name ? 3 .....�o-In,.---- ...........................License# ....r`.�7.�. -31 PF►one --�••�'• � - 11� <br /> Installation will serve: Residence rtntent House 0 Commercial OTrailw Court 0 <br /> Motel Q Other <br /> Number of living units:-......... . Number of bedrooms . , ..Garbage Grinder . .€.:i.. Lot Size .�� ..I...�.. . <br /> Water Supply: Public System and name ----- __—.......... ........................._....... .........................Private <br /> Character of soil to a depth of 3 feet: Sand[] Silt Q Clay Peot C} Sandy Loom 0 Clay Loam D <br /> Hardpan❑ Adobe Er Fill Materlat/1.-.T..If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet, r <br /> PACKAGE TREATMENT j SEPTIC TANK 1.�' <br /> Liquid Depth ./...Z:........Capacity . : ?.._._... Type PiL. �... Material.- :x-2= SNo. Compartments ......2 ........ w <br /> istance to nearest: Well _. �. ��" ............. ......Foundation .. !L�...... Prop. Line .....�)....... <br /> LEACHING LINE No. of Lines = Length each line.. J..'`?� .}1..... Total length .....i <br /> ._ _ .. . . .............. <br /> 'D' Box -- Type Filter Material .......Depth Filter Material ...1.611................. ........ <br /> ..... <br /> istante o nearest: Well .... i. �............. � '....... . <br /> I Foundation .. Property Line .. <br /> SEEPAGE PIT De th . Diameter ................'a tl�.._ Number _ N <br /> p --_------ �... Rock Filled Yes No (] 0 <br /> Water Table Depth .......... .........................Rack Size • -� 1zP­/` <br /> - !� �...........- <br /> Distance to nearest: Well ....... _ 'L.r...................Foundation ....1..�./`...... Prop. Line : .�........... <br /> REPAIR/ADDITION(Prev. Sanitation,Permit# ...... .................................... Date .................................. <br /> Septic Tank (Specify Requirements) <br /> DisposalField (Specify Requirements) ---......--•-•................••.........----•---- ---.-----•----............................. ............... <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 accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Nealtl,Wstdtt. Hoare owner or Nem <br /> sed agents signature tett€ties the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shell 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 <br /> (If other th r - --- --•---- -------��............... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..-._.-- DATEa ..�-_3- 17 <br /> . --.--_-_--- <br /> BUILDING PERMIT ISSUED ------------------------ ---------..................DATE - ----------------- ................ <br /> ADDITIONAL COMMENTS ..------- ..-.................... ...... <br /> _._.. - <br /> ------------ - ----------------- ------- .-----._........_.._...._.__._.._......:..----..._.........._..........._..._.............----.------------------ --------•--.........-- <br /> - ---------------- ---------------------- ---•-•-- -----....-,.---_- ........- -------_---------..----- -------------------- ------ <br /> -----------•- -- -------. -- --••-• ---...._..-•----....... -----•.............. ----- <br /> FinalInspection by: . C..�.. . .... . . .....•••••---••---..----•-----•-..............•....... .................--- ----• --- Dae .. ./.. ..... <br /> H 13 2 1-613 Rev. SM SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7b 3M <br />