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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 3 5 <br /> Permit No. 7�=--�-= ---- <br />----------------------------- <br /> (Complete in Triplicate) <br /> Date Issued g��-----���• <br />----------------------- <br /> ------- 42A--O <br /> --------------- ---------- <br /> This Permit Expires 1 Year From Date Issue <br /> the work <br /> Application is hereby made to the San Joaquin Local Health District nan e for a permit <br /> to construct and and existing RulesandRegulationsrein <br /> described. This application is made in c�p�y wi ��gyS� <br /> "V-------CENSUS TRACT -------------- ----- - --- <br /> JOB ADDRESS/LOCATION ._ - ` " - <br /> Phone ------------------------------------ <br /> ------------ --------- <br /> Owner's Name --- <br /> _ City -- --OC&1G'/i/--------------- - - <br /> ------------- --------------------------- - - <br /> s 7----- <br /> Address ----- �/4��-------- --------- ---- - -- Phone 1�7 <br /> License # � i _r3 <br /> Contractor's Name <br /> Installation will serve: ResidenceA]Apartment House❑ Commercial []Trailer Court ',❑ <br /> Motel ❑Other -------- - ----- --- - - - <br /> Number of living units: ---— Number of bedrooms ___�_____Garbage Grinder _/_ -- Lot Size _/&�-%�CV0--------------------""-- <br /> Private ❑ <br /> Water Supply: Public System and name ------------------------------------ peat Sand Loam El Clay Loam ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ❑ Y <br /> Fill Material _-_ --______ _If yes,type <br /> Hardpan] Adobe E] ----------------------- <br /> laced on reverse side.► <br /> (Plot plan, showing size of lot, location of system in relation to wells, <br /> buildings, etc. must be p ILV <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> Size-------------- _ Liquid Depth --- --------------------- <br /> SEPTIC TANK'[ J ----------- ----------------- - <br /> PACKAGE TREATMENT [ ] __"_ No. Com artments <br /> Capacity - - -- - -- ------ Type -------------------- Material__ _ ___ P ---------------------- <br /> I <br /> Distance to nearest: Well ------------------------------------Foundation ----- ------------ Prop. Line-._._.__.------------- <br /> LEACHING LINE No. of Lines ------------------------ <br /> g _ <br /> - <br /> Length of each line---------------------------- Total Length -____---------------------- <br /> [ J <br /> 'D' Box ------------ Type Filter Material ------------------- P <br /> Depth Filter Material -------------------------- ----------------- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Proer Line ------------ ----------- tl-------------------- P <br /> - <br /> Depth Diameter ______ Number _-_-__-_----------------- Rock Filled Yes ❑ No 0 <br /> SEEPAGE PIT [ ] p --�----" _ <br /> -------------------- <br /> Water Table Depth ----------------------------"------------------- <br /> Rock Size ------------------------ - <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -_.------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------- <br /> Date ----------------------------------) <br /> Septic Tank (Specify Requirements) __----------------------------- ---` - ----- l� <br /> Disposal Field (Specify Requirements) ......-.0,9------1a---0-r_-� <br /> -------------- <br /> ----------------------------------------------------------------- <br /> ---- -- - - - - - ------------- - <br /> -------"- ------------- (Draw existing and required addition on reverse side) <br /> ne in <br /> ce <br /> h San <br /> I hereby certify that I have prepared this application <br /> Regulations nd that <br /> of the San Joaquin Local D stratnHometowner or I ten <br /> County Ordinances, State Laws, and Rules and <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 ark a Js Compensation laws of California." <br /> Owner <br /> ---------------------------------- <br /> Signed ---------------------- ------- <br /> .` -------------------- <br /> (If <br /> — Title ---------------------- ------------------ ------------------- ---- <br /> Y ---- ------------------- <br /> - - -- -------- ---- <br /> (If of er th owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- cf_�`-G`�------------------------------------------ - ---------------------- DATE ---DATE ------------- - --------------------------- <br /> ---�--------D"�----------------- <br /> BUILDING PERMIT ISSUED ----------------------------------------------------------------------------- --------------------- <br /> - <br /> ADDITIONAL COMMENTS -------------------------------------------------------------------- ----- <br /> -------------------------------------------------------------- <br /> ----------------------------------------------------------- <br /> --------------------------------------------------- <br /> -------- ------- <br /> ____ ------------ - ----------------Date ----�,` �� ------------------- <br /> ------ <br /> ----------------- <br /> - - -- ------------ -------------- - - --------------------------------------------------- <br /> Final Inspection b - -"----"-""""--� <br /> - -- ---------------------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r u 0 1.'AR Rev. 5M <br />