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FOR OFFICE USE: <br /> ----- ----------–---------- ----------------------- APPLICATION FOR SANITATION PERMIT Permit No <br /> (Complete in Triplicate) ------ <br /> Date <br /> ------------- -- -------------------- T Permit Expires I Year From Date Issued Issued <br /> - -- <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-Fegulations: <br /> JOB ADDRESS/LOCATION ----------------------- ------------------CENSUS TRACT .._ -- `------ <br /> Owner's Name ------- ---- - ----- --- --- --------- --- ------------------------------------------- -------------------Phone - <br /> ----------------------------------- <br /> Address _* <br /> /447 _Z tic:&,ti2;– ------------------------- City --- ---------------------------------------- <br /> 01 <br /> Contractor's Name ----.License # Phone <br /> Installation will serve: Residence WApartment House,E] Commercial E]Trailer Court Cl <br /> Motel F <br /> -1 Other -------------------------------------------- <br /> Number of 'living_units:__/__.7.1_ Number of bedrooms __-__Garbage Grinder ------------ Lot Size ----e5zI ----------- <br /> WaterSupply: Public System and name ----------------------------------------------------------------------------------------------------------------Privateo <br /> Character of soil to a depth of 3 feet: Sand'F-1 Silt[] Clay E] Peat R Sandy Loam ❑ Clay Loam <br /> Hardpan E] Adobe E] Fill Material 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 s;eep��e pit permitted if-public sewer is available within 200 feet,) / . <br /> PACKAGE TREATMENT SEPTIC TANK! Size------5-------X----I---e----- Liquid Depthtom --------- <br /> 'Ca acity /60-45------- Type No. Compartments ............... <br /> -a 11 <br /> i 16 <br /> /s.taonfce to nearest: Well ------------------Foundation .... ----------------- Prop. Line ----- -_------------ <br /> LEACHING LINE No Lines -------P—----------- Length of each line/$V%X1357 Total Length ---3_1_6............... <br /> D' Box Type Filter Material ___j__1'.-__-__-Depth 'Filter Material ___t_17._________________________••.. <br /> Distance to n F arest: Well __/_d--6__----__-__--Foundation __-____/6______:.__.- Property Line ---��!=.............. V'N <br /> SEEPAGE PIT f-v- Z' Rock Filled Yes 0--`N_o_C] - <br /> Depth '1A-------------- Diameter Number --------------------- ------ Oc/K e <br /> 37 Water Table Depth ------ ----------------------------------Rock Size - _Z� 7 <br /> Distance to nearest: Well ----------------------------------------Founclat'/n -------------- Prop. Line _.___.__...._.........V+ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------_------_----_--------_-) Y, <br /> SepticTank (Specify Requirements) ---- -------------------------------------------------------------------------------------------------------------------------------- ........ <br /> DisposalField (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------- ------- ------------------------------------------------------------ <br /> -------------------------------------------- ----------------------------------------------------------------I--------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <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 /> ----------- " <br /> By Title <br /> a� owner) <br /> -------------------------------------------- - ------------other than <br /> (if oth- �r th'cy'n <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- ----------------------------------------------------------------------- DATE -----7_7=,IY=_7_3...... <br /> BUILDINGPERMIT ISSUED ------------ ------------------------------------------------------------ ---------------------------------DATE ------------- --------------------- ------- <br /> ADDITIONAL COMMENTS <br /> ?-- -------------- --- ----- - -------------- ------------------------------------------------------------------ <br /> - -- ---------- --------------------------------------------------------------------------------------------------------------- -------- <br /> ---------------------------------- <br /> -------------------------------------- - --- - ---- ------------- --- --- -------------------------------------------------------------------------------------------------------- <br /> 4K�__ <br /> ----------------------------------- - -- --- ---- -------------------------------------------------- <br /> Final Ins n b - __ e- -3 <br /> - ----- -- -- ------ - Date --- ----------------- _-Z---- ----- <br /> SA <br /> --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />