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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No 7 <br /> \ (Complete in Triplicate) ' ""' <br /> .,..��. �u .. 11 Date Issued <br /> ............. <br /> y ...., 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 heroin <br /> described. This application Is made in compliance with County Ordinan a No. 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LOCATION c ..�L.—/� ..... .... .. ... ... .... �� ..............CENSUS TRACY` .......................... <br /> Owner's Name .. . ........... LrY .. ........... L.. ... Phone .................................... <br /> Address ...................-2 3. .,, ,. ..� ................... City .��. ttt:� .............................................. <br /> Contractor's Name .........Cf"��� t ; 4 ..�� ..� ;:ktcense # Phone <br /> Installation will serve: Residence CkApartment House❑ Commercial '❑Trailer Court fl <br /> Motel ❑Other ............................................ <br /> Number of living units:........ Number of bedrooms .. A .Garbage Grinder'.'. Lot Size ......1... ............. <br /> Water Supply: Public System and name ... .�.' ......i v... ....................................................Private <br /> Character of soil to a depth of 3 feet: Sand 0 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 INSTALLATIONt (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK-P Siz-e�,c,�Q., .��iE .. . . ........ liquid Depth ..�.................... v <br /> Capacity/ cv r. c Type ��: . Material.... No. Compartments .....S:........... <br /> Distance to nearest: Well ....:5.` ....................Foundation ..lQ........... Prop. Line ....A ........... <br /> LEACHING LINE P' No. of Lines .......,l............... Length of each line....../��<�'; ....... Total length .. ../..6r'1.. ......... <br /> 'D' Box--&�.v.... Type Filter Material . k ....Depth Filter Material ....4 ..` ........................ <br /> Distance to nearest. Well ............. Foundation ....... Prop Property <br /> Line ..�................. <br /> SEEPAGE PIT Depth . .-......... Diameter .:�.. Number ...../........... Rock Filled Yes C�Y No O <br /> Water Table Depth .......,,J�'-. .......... ....................Rock Size ....A...................... f <br /> Distance to nearest. Well .... Cf�l. ......................Foundation .%a..�....... Prop. Line ..... <br /> ..�...�....... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) <br /> SepticTank (Specify Requirements) .........................................................................................................._............... ................. <br /> DisposalField (Specify Requirements) ................................................................................................................................. <br /> ......................................................................................................................................................................................................... <br /> (Draw existing and required addition on reverse side) <br /> 1 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 IleetM <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 ................................�r.................. ...!...� .................... Owner <br /> By ....................�����Yc.�,.,.� .......... Title .......�...... . ............................. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... ...... .. ........................................................ DATE ....... .$.. ........... <br /> BUILDING PERMIT ISSUED ............................. ............................................................................DATE ........................................... <br /> . <br /> ADDITIONALCOMMENTS ..................................................................................................................................I........................... <br /> ........................................................................................................................................................................................................... <br /> :..................................... .....• ............ .......................................... .6.Z . ` �. ................... <br /> ........ . .. .. .. .. .. <br /> ..... :. ..... . .... ... .. <br /> ..... . .. .. <br /> Final inspection by: ..... c,1 . .... . ......... ..... ...............Dste .......... . <br /> SAN JOA0UIN LOCAL EALTH DISTRICT <br /> ZDO7 <br /> L3 24 / <br /> E. H. 1 68 Rev. 5M <br />