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FOR DEFACE uSE% APPLICATION FOR SANITATION PERMIT <br /> .................................................. Permit <br /> (Complete I"Triplicate) •��'. <br />..............�./ . . .......I....................... This Perfnit Expires 1 Year From Date Issued Date lnsued <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 /> f <br /> JOB ADDRESS/LOCATION .:. 2.:r_% .Q...........: ...... .......'.............................CENSUS TRACT ........................... <br /> Owner's Name f...... - -•................... ..••--....... .,.....................................Phone .................................... <br /> Address ..�-pL.l._..f7G. = ...........City .... �..... ......... ....................................... <br /> Contractor's Name .... '- - ...... --.......... license .rL_ A Phone <br /> Installation will serve% Residence[aApartment House[] Commercial❑Trailer Court 0 <br /> Motel❑Other <br /> t Number of living units:............ Number of bedrooms 5 Garbage Grinder Lot Size --------- .................................. <br /> 4 Water Supply% Public System and name ...:...............................,.........--.-........_-...... ............................... Private❑ <br />' Character of soil to a depth of 3 feet: Sand r] Slit❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan® Adobe flFill Material ......... If yes,type............... ` <br /> �. <br /> o <br /> {Plot plan, showing size of lot, location of system in relation to welts, 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,l 0 <br /> PACKAGE TREATMENT [ 1 SEPTIC TANK I I Stze:::....................................:::... �Uquid Depth ...... ................... <br /> Capacity � �1 Type .. .............. <br /> Material.....:.........:...... .No: Compartments ... '=--._.... <br /> ' Distance to nearest.. Well IA© .. ....Foundation ...................... Prop. Line <br /> i LEACHING LINE { ] No. of lines _.. ................ Length of each_line...Z..................... Total Length <br /> p �© `f ICJ,..,...---- ; <br /> 1 <br /> 'D' Box Type Filter Material _ __ .Depth Filter Material . <br /> k . , Distance to nearest: Well ....................... Foundation ........................ Property Line .........•........= . <br />',. SEEPAGE PIT [ [ Depth .................... Diameter _...--._._..::.. Number ...._....-:....... ........ Rock Filled Yes ❑ N4 I] <br /> Water Table Depth ----•-----•.....................................Rock Size --••-----•..................... <br /> Distance to nearest% Well ............ .... Foundation --••--•--....••..... Prop <br /> • <br /> tins --- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .................................. . Date .................................. <br /> SepticTank (Specify Requirements) ---•••--•....................................................... ........................................._................................ <br /> Disposal Field [Specify Requirements) .................................................. •--.......---................-•-•------... .............................. <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 Mules and Regulations of the San Joaquin Local Health District. Horne owner or liters• <br /> SW agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to becom subject to Workman's Compensation laws of California." <br /> Signed ......--- ............. ........-_..... Owner <br /> By ................ .1 ----... ............ .. .............................•--•-----•----•--•-•-. litle .................................... ................................... <br /> - (If other than owned <br /> Foie DEPARTMIiNT USE ONLY <br /> APPLICATION ACCEPTED 8Y . •--r................................................................................ DATE ....- .�� ...7 ........ <br /> BUILDING PERMIT ISSUED .....................................................................................I.—.................DATE ..........----- ............. <br /> ADDITIONAL COMMENTS <br /> ..................................-.....................-•--------••--..........:.........----•----•-•.......-....................................... ....................-----......�................ <br /> ........-. .............................. ............. <br /> final ins ection b . .......Date ... fb .. ..................... <br /> p y ..................... ......_....---•--................................ .... <br /> EH' 13 2h 2.68 Rev. 5N SAN JOAQUIN LOCAL HEALTH DISTRICT $/7h 3M <br />