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r <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> - Permit No. <br /> (Complete In Triplicate) <br /> This Permit Expires >I Year From Dale Issued Date issued <br /> ....................................... <br /> Application is hereby made to the San Joaquin Local Health District for a per 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/LOC TIONgl.. .. .._. .._ `���/ 'T .T�..........CENSUS TRACE ....... .. <br /> Owner's Name ._. ® J _.... Cd ..Phone .. •1� �' .. <br /> ........--- <br /> Address -•-•• `w .. -`-- p ............... City ............•....................... ...... <br /> i <br /> Contractor's Name . � _� .. �1 +> 4��?5�..... "t cf----------.License # -------------------- Phoria <br /> Installation will serve: Residence Apartment House 0Commercial ❑Troller Court 0 I <br /> Motel❑Other -----------------------•------------------•- <br /> 10 <br /> Number of living units*---- Number of -bedrooms .2_....Garbage Grin er .._.. ------ Lot Size -?- .__i2 --•--••...-•--••.. <br /> Water Supply: Public System and name,_. .............C—.[9. -f .---- . - . <br /> .................... Private 0 <br /> Character of soil to a depth of 3 feet: Sand❑ _Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ , Clay Loam <br /> Hardpan ❑ Adobe.❑ 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 /> R ' <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) . . <br /> PACKAGE TREATMENT [ I SEPTIC TANK{ ] Size................. .............................. liquid Depth ........-......•........ <br /> .- <br /> Capacity - Type _ Material---------------------- No. Compartments ....................... <br /> Distance to nearest: Well ....................................Foundation ...................... prop. line ...................... <br /> LEACHING LINE ( ] No. of Lines ------------------------ Length of each line............................ Total Length <br /> 'D' Box ............ Type Filter Material ..... ............Depth Filter Material ......................................... <br /> Distance to nearest: Well ........................ Foundation ...............0........ Property Line ----:........ <br /> SEEPAGE PIT [ j Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No (] <br /> Water Table Depth -•--••--•.................. ................:...Rock Size .......... ...................... . <br /> Distance to nearest: Well........................................Foundation .................... Prop. Line ....................... <br /> REPAIR/ADDITION(Prev. Sanitation'Permit# ............................................ Date I <br /> Septic Tank (Specify Requirements) ....... ....................-................... <br /> Disposal Field (Specify Requirements) �? 1 1?7 Ct.1. .- �' - -- ••• ` ma ..... <br /> =--_---_ <br /> ...Fd <br /> --------------------------------------------------------- <br /> .... -----------------------------------...................................................................................................... <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 San- Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Herne 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 sholi not employ any person in such manner <br /> as to hoc o subject o Workman's pensation lawjef alifornia." <br /> Signed .. u� ' . . .......... Owner <br /> BY • . . ... ....... .....................� N�` � . Title ... ......:....._......_.._.__....... <br /> (if other than owner) lJJ <br /> FOR DEPARTME T USE ONLY <br /> APPLICATION ACCEPTED BY L[ / ......... DATE .��. .' 7 f ....... <br /> BUILDING PERMIT ISSUED .DATE <br /> ADDITIONALCOMMENTS ............ ... ........... ........................ .............................................--------- ...........:................ <br /> Final Inspection by: ............... --- .... _.. .. ... ..... --•--..._ _ <br /> ------•--.................... .... Date .. .. <br /> SAN.'JOAQUIN OCAL HEALTH DISTRICT <br /> 14 13 24 I.-ea ge.._ Slut <br /> 7/723 K <br />