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FOR OFFICE USE: �—APPCCi ATION FOR SANITATION PERMIT /p <br /> -----------------------------------•---------------�.:-._, Permit No.� S =- <br /> - ----��---�-� <br /> ---------=---------------------- ----------------------- (Complete�n Triplicate)\� <br /> Date Issued 'ja- <br /> --------------------------------------------------------- �a This Permit Expires 1 Year From 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 .___/0__4?0.0-___S_ !_-e2rV17 ___CENSUS TRACT ------- <br /> Owner's Name --- __ _ y - ____ Phone <br /> Address ------- Q-$; --1Z-��'+^-�j-_ae2- - -----------------------------. City/e o.✓ ----------------------------------------------------------- <br /> Contractor's Name ---------- i���`'-------------------------(/-----------------------------------License # ------------------------ Phone ---------_------------------- <br /> Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other -------------------------------------------- �ff <br /> Number of living units:___I____ Number of bedrooms 3------Garbage Grinder P-"P_____ Lot Size _/-/) ___________________________ <br /> Water Supply: Public System and name ------------ --------•-------------------- --------------------------------------------------------Private [ ` <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 /> NEW INSTALLATION: (No septic tank or seepage, it permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK ------------------- Liquid Depth <br /> Capacity 12 ------.__ TypeO _4 ---__ Material,:�A'W_eee,�_ No. Compartments ____�_......_.... <br /> Distance to nearest: Well __, -- _________________________Foundation ______________ Prop. Line ____ <br /> ....... O. <br /> LEACHING LINE Pj-- No. of Lines __J------------------ Length of each line----04�`------------- Total Length ,__4.'94;?............. <br /> D' Box _4,Bo___ Type Filter Materi0*Xr_ _Depth Filter Material ---------,� _ _______ ___ ___.____ <br /> Distance to nearest: Well --- 7q------------- Foundation ._-RJ _ ��f - - <br /> � ------__-_-- Property Line ----___--- ...... <br /> SEEPAGE PIT [ ] Depth ___________________ Diameter ---------------- Number __________________________ Rock Filled Yes ❑ No i❑ <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----.---------------------------------__Foundation ----------- -------- Prop. Line _-_____----._.___----- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ___----------------------------------------- Date ______-_____________--__----------1 <br /> SepticTank (Specify Requirements) ------- ----------- -------------------------------------------------------------------------------,--------------------------•- <br /> Disposal Field (Specify Requirements) _________________________________ <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. Home owner or licen- <br /> sed agent •signature certifies the following: <br /> "I certify at 'n the erformahce of the work for which this permit is issued, I shall not employ any person in such manner <br /> a be o e biec Workman's Com n tion laws of California." <br /> Sne ---- --------- -------------------------------------- Owner <br /> BY - -- -- ----------------------------- Title ------ - ------ <br /> (If of r than o ) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - - ----- ----- DATE ---/2=67aF*---------- <br /> BUILDING"PERMIT ISSUED ------------------------------------------------- -------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ------ ----- ------------------------------------------------- --------------------- ---------------------------- ------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------_------- <br /> ------------------------------------------------- <br /> -------------- <br /> ------------------------------------------------- ------- -------------------- ------------------------------------------------------------------------------------------------------------------------ <br /> ,moi <br /> --------------------------- ---------------- - ---------- ----- ------ --------------------------------- --------------- ----------- <br /> Final Inspection b - ---- ------ =` -- -------------------------------------------- �r <br /> P Y - Date f <br /> OAQUIN LOCAL HEALTH DISTRICT <br /> c <br /> E. H. 9 1-'68 Rev. 5M <br />