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FOR OFFICE USE: <br /> VAPPLICATION FOR SANITATION PERMIT <br /> P------!............................ Permit <br /> (Complete in Triplicate) <br /> •............... <br /> This Permit Expires 1 Year From Date Issued Date Issued <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 /> JOB ADDRESS/LOCATION ...".-..-/ )�.;o 9�..--:_� fo.....................................................CENSUS TRACT .........:....:...... <br /> <.... <br /> Owner's Name ....... ...... <br /> Y <br /> �.��?`Pi...... /Y•!e-� Phone:._....................... <br /> Address ......................._.._._...._....._.... .......... ...... •-----------.....--•••-....... City ---------........._.........I............................................. <br /> Contractor's Name . .-f.*74._VWX Sd,6............................License #`�z��r�'�'.:.. Phone <br /> Installation will serve: Residence [] Apartment House❑ Commercial :QRTrailer Court <br /> Motel [7 Other ......... .:.:�.......................... <br /> Number of living units:............ Number of bedrooms ............Garbage Grinder ------------ Lot Size ..__:.;_..__.. ............................... <br /> Water Supply: Public System and name .....................................-----------------...................................................._.Private [ . <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat0 Sandy Loam ❑ Clay.loam ❑ <br /> Hardpan ❑ Adobe❑ Fill Material ------_-_-_ if yes,type ----------------------------- <br /> (Plot <br /> - ::"---------(Plot plan, showing size of lot, location ofsystem in relation to wells, 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,} <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size... _._.._-_ t <br /> -----... Liquid Depth ...�.................. ) <br /> Capacity __�. © --••-- Type loee..4 f T Material..<.PW4. �_... No. Compartments ... ..........� � <br /> Distance to nearest: Well ..................:.................Foundation ...�P..._.......... Prop. Line .......• <br /> LEACHING LINE [ ] No. of Lines ....._._,�__--____---- Length of each line--------R--O___--------- Total Length _.114!.`.......:.... <br /> jj /, <br /> D' Box .__f------- Type Filter Material [.�z.. .G .Depth Filter Material -____.a. r� . . <br /> Distance to nearest: Well ........................ Foundation. ........................ Property Line ................ <br /> SEEPAGE PIT [ ) 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 ..................................) <br /> Septic Tank (Specify Requirements) ............................---••...............................-.....................-................................................ <br /> ..... <br /> Disposal.Field (Specify Requirements) ..................................................._..............._..----------•---_---------.----------------•---•-------•---...... <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. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that iwthe performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .......A_1 lAV.71i._ri . ......�_• ;FQ /-------__--•--•----... Owner <br /> By .......... :._ ... ----------------- Title ............- <br /> (If other .................................. <br /> FO DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... ..........:.. J 9� <br /> - ----------------�•---........------......_....--•--._..._....--'------.. DATE ........ .. ��..�.----•--.. <br /> BUILDING PERMIT ISSUED ...............•---------------------------------•--...:.: DATE ............................... ........ <br /> ADDITIONALCOMMENTS ..................•-----•----......._.........._......._............----..............--- ..........:-------.................. <br /> .. <br /> ..............•..---------------------------------------------------------------------••-.........._...----..........._._.._..._....._......_.. <br /> ...................................:............. <br /> - . . . ................... <br /> Final Inspection by: ---•---...-- .............: . ......Date <br /> SAN JOAQUIN AOCAL HEALTH DISTRICT <br /> _ E. H.13 241-'68 Rev. 5M 7/72 3 M <br />