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R ♦ ti+' <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 5 3 <br /> 7 <br /> --------------------------------------------------------- <br /> Permit No. �-�-�---------- <br /> [Complete in Triplicate <br /> ---------=- ----------------- ------------- Date issued <br /> This Permit Expires 1 Year From Date Issued <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. 3.49 and:-existing Rules and Regulations: <br /> / �_r- ..,CENSUS TRACE = <br /> JOB ADDRESS/L CATION -G� `-' -- -----" " � :� " <br /> �1 -Phone --------------- <br /> Owner s Name -�- - ------ ����'-�-� -- -�°---------------------- --------------- -- - -J-------- � ; <br /> Cityvokl ltl -------------------- ------------------ ------ <br /> AddressL : � <br /> License # � Phone <br /> Contractor's Name - -1 -,..---L--=�1 �/ ----------------------------------- <br /> - � 1 <br /> Installation will serve: Residence D)Apartment House❑ Commercial ❑Trailer Court i❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units------------- Number of bedrooms ----"-------Garbage Grinder ------------ Lot Size .--_---------------- ----------------------- <br /> I + <br /> Private <br /> Water Supply: Public System and name ---------------= ----------- --------- --------- -- ------------------------- ------------ ------------- <br /> Character of soil to a depth of 3 feet. Sand'[3 '$ilt}.❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ <br /> Hardpan ❑ , �A4obe '❑ 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 seepage pit permitted if public sewer is available within 200 feet,) <br /> ----------/Liquid Depth --------J------ ---------• d <br /> PACKAGE TREATMENT" [�] SEPTIC-TANK�[ ] � Siz .-----_------------------------- •- q P <br /> —1' --- Material---------/Filteriter <br /> - N Compartments ------.---------.----- <br /> ,� � Capacity -------- ,��------- Type --------------- - p <br /> Distance to nearest: Well -------------- ---------------------Found ------- ------------- Prop. Line ----_--•-------------- <br /> LE'ACHING LINE- [ N'o. of Lines --------------------:---- Lengt of each line--------- ------ -- Total Length ------.----_._-.-_-.-------- <br /> D' Box ------- --- Type Filter Materi I --------------------Depthr aterial -------------------------------------•------ <br /> Distance to nearest: Well ------ -- -------- Foundation -- -- --- --- -- Property Lirie _-----••-----••----•-•- <br /> . 1 - <br /> SEEPAGE PIT Depth Diameter - ------------ - Number ------- ------------ Rock Filled Yes ❑ No (][ ] P =Water Table Deth -----------------------------Rock SDistance to nearest: Well -------- ------------------------------ Found -------------------- Pro Line -_-----------.------REPAIR/ADDITION(Prev. Sariitation Permit# ------------- �--------------- - Date - --------------• ------) <br /> Septic Tank (Specify Requirements) ------------------ - ------------------- --------------------------- <br /> Disposal Field (Speci?y Requirements) ---------------------------------------------------------------------------------------- <br /> / J(-------- <br /> ------------ <br /> - "`--------------_-•-------------------------------------------------'- <br /> - -.-- --- ------------------------------------- -`.- -----.�'+r <br /> [Draw existing and required addition on reverse side) <br /> I hereby certify.that,l 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. Nome 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 - T Owner <br /> Title ----- --------- -�- <br /> (If other than owner) �`' <br /> FOR DEPARTMENT USE ONLY 7 <br /> APPLICATION ACCEPTED BY -- 1-1--- -- ------------ --------------------- ------------ -----------------------------• DATE ---- ----- =/ ---------•--------- <br /> BUILDING PERMIT ISSUED ------------------- ------------ <br /> --- ---------------------DATE ------------- ---------------------- ------ <br /> ADDITIONAL COMMENTS --------- ----- -- --- -- ----------------------------- ---------------------=------------------ <br /> - ------ --- -------------------- --- --------- ------- - -------- ------- -------------­-------------------------------------------------- <br /> --------------------------------------- ------------ - --- =--------- = - ----- - -- ------ - ------ ------- ----------------------------------------- - -- <br /> •. -� <br /> - -------- <br /> --- : <br /> ---------------------------------------- ateFi ral'Ins ection SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M <br />