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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT <br />....................................................... Permit_No. <br /> (Complete in Triplicate) <br /> S =l' ate�l3su0cf/ <br />........................................................ This Permit Expires i Year From Datehisved ' , <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 Coun y Ordinance No. 549 and existing Rules and Regulations <br /> JOB ADDRESS/LOCAT Q.., .......................... .........................CENSUS TRACT .......................... <br /> Owner's Name ........ 1.1Qe�....................................................... ....Phone ...4/K--fM..... <br /> Address : .......... :.. ..... City _.. ............................ <br /> ..... ...... ....... <br /> Contractor's Name ......_......... . .,}..... �..... ...a l2 -1�..1PL ...License# ........................ Phone i :���.Q. .. <br /> Installation will serve: Residence*partment House(] Commercial QTrailer Court l] <br /> Motel Q Other............. .............................. /� <br /> Number of living units:.. .'...... Number of bedrooms�.....Garbage Grinder Lot Size 6� r-f- l3• ..... <br /> Water SuPPIY= Public System and name .............. ................................... .;... .:!l� ..,� `X: .........Private Q <br /> Character of soil to a depth of 3 feet: Sand Q Slit Q Clay Q Peat Q Sandy Loom 0 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK( ] Size................................................ Liquid Depth .......................... <br /> Capacity .................... Type .................. material...................... No. Compartments ......................� <br /> Distance to nearest: Well ................... ....._.....Foundation ...................... Prop. Line ..........•. n <br /> LEACHING LINE I ] No. of Lines ........................ Length of each line............................ Tata) length <br /> .................. ........ <br /> 'D' Box .......... Type Filter Material ....................Depth Filter Material ............................................ <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT [ ) Depth Diameter ................ Number ............................ Rock Filled Yes Q No Q <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) ........ .7..... .........................._. .- ........ .�... <br /> Disposal Field (Specify Requirements) ---•-• ...... ......... .. .. ................ ...... ..... ........... <br /> £ ...........................:....................... .... <br /> 4::P _ ..K.Z..,1,._.... '••........................... <br /> ............................ .........................................._..... _............ . <br /> ......_...............: ..,.............•---.. .......................................................... <br /> (Draw existingand 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 Sar Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Home owner or Nun- <br /> sod agents signature certifies the following: <br /> "I certify that in theperform of the work for which this permit is issued, 1 shall not employ any person In such manner <br /> as to becomes sect to W n's Compensat laws o California." <br /> Signed ..... G+' 11. -_a .. •Uwwer <br /> By ........................................................... .. <br /> ........... Yitle .. � '.................................. <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY'.. j . : � ...... DATE . <br /> BUILDING PERMIT ISSUED ........ ............................................. ... ........�...............................DATE ....................r....9..............-.....�..j..l..'.a.r.m. <br /> ADDITIONALCOMMENTS ........................................................ ............................................................... ........................... <br /> �. ..... <br /> .....:.. ............. ...... .................. ... ........... .................................................... <br /> .................................=": ........... ,, ... .. ............. ......... .... . Y.... <br /> Final Inspection by: ......... . ..�.... :.. ... .............Date . H <br /> - ` <br /> SAN JOAQUIN LOC HEALTH DISTRICT <br />