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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> d <br />--.._..-._... Permit No. ...................../07 <br /> (Complete in Triplicate) <br /> _ . . ....... ... 7(( <br /> ........ This Permit Expires t 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 mode in compliance /withCounty Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ._..... / ZJ. . .. ` .. 4.!9 ? ' / __... .-._._. ...... ._ .... ..CENSUS TRACT .......................... <br /> Owner's Nome ..:........V. .h..1..... C�. ... 3 7.....:.Crr�✓lam r Phone ... <br /> Address < ' - <br /> _ '�.. City %'r/ �`. �. ........ ................. ........... <br /> Contractor's Name �. � /. G!� ,n -------- __ .-......... -_. .....License #d;'6, �i`�. Phone <br /> Installation will serve: Residence 5'Apartment House,❑ Commercial ❑Trailer Court a <br /> Motet ❑Other _ _....._ .......................... <br /> Number of living units:_ Number of bedrooms ...:...Garbage Grinder lot Size ..._ ...................................... <br /> Water Supply: Public System and name _ ----------- ----------------- -..._.. ---------------_----_- ................................Private Im <br /> Character of soil to a depth of.3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam J Clay loom ❑ <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 ..................... <br /> LEACHING LINE [ ] No. of Lines . Length of each line Total Length ............................ <br /> 'D' Box . . Type Filter Material ..-----------.......Depth Filter Material ...._.. ................................... <br /> Distance to nearest: Well ........................ Foundation _ _. ._...._.._. Property line ........................ <br /> SEEPAGE PIT [ j Depth _._. Diameter ................ Number . .... _ . ............. Rock Filled Yes ❑ No C] <br /> Water Table Depth ... -------. .................................Rock Size _ ............................. <br /> Distance to nearest: Well _.- ----- ...... ......Foundation ..._ ....- ._...-_ Prop. line ...................... <br /> REPAI ADDITIO (Prev. Sanitation Permit # .--.... ..----------......._ Date --- .................... <br /> Septic Tank (Specify Requirements) _ _ ---.. .. .. ........------- ....................................-- .............. <br /> Disposal Field (Specify Requirements) .-----r:2-.�1. ._-- --f i- ----- -- __._, ----- ....... <br /> --- . -- F <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. Homo 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 t ork an's Compensation laws of California." <br /> Signed --------- ------------------------ ------ Owner <br /> By . .. _. .-... Title <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ DATE . "t..�.' ........ <br /> ..- <br /> BUILDING PERMIT ISSUED _ ............_...... ....... ..._ .. _. _DATE . ................ . _ ............ <br /> ADDITIONAL COMMENTS ......--------- ------------- _... - - ............... <br /> ----------- .... ... _. -._ _...................... . <br /> - - --.. - --- ..................... .................. <br /> .. ...... . .......... .. . <br /> .... <br /> Final Inspection by: .... ------ ........ ... .............Date ... ,. .......\..:.....­ ............... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 241-'68 Rev. 5M 7/72314 <br />