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FOR OFFICE USE: 6_4 AppLICAVON--FOR SANITATION PERMIT <br /> ----------------------------------- --- ------ Permit No. 7.3'�3� <br /> --- --.--. <br /> (Complete in Triplicate} ---_ <br /> ------ <br /> � -� � <br /> -- - <br /> --------------- ----------------------------------- This Permit Expires 1 Year From Date Issued Date Issued w/. <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 incompliancewith}County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ------ -��--1._---:--40,...02447------------- - ---------CENSUS TRACT -----------------•--_-- <br /> Owner's Name _-�s►7t[� � It 1 a-[&L",---- ---------- -------------------Phone <br /> Address / ------ <br /> Contractor's Name A ------------------License Phone <br /> Installation will serve: Residence Apartment House-[] Commercial :❑Trailer Court ',❑ <br /> Motel ❑Other -------- ----------------------------------- <br /> Number of lZL�� <br /> - Number of bedrooms ______Garbage Grinder ------------ Lot Size _______________-________________.____ <br /> WaterSuppind 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 pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f ] SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth __-________________,_____ <br /> Capacity -------------------- Type -------------------- Material---- No. Compartments ------------•--------- J <br /> Distance to nearest: Well ------------------------------------Foundation ------ --------------- Prop. Line ----------------------- <br /> LEACHING LINE [ ] No. of Lines ________________________ Length of each line--------------------------- Total Length ________-___--__-_--.---_.__� <br /> i 'D' Box ------------ Type Filter Materia) --------------------Depth Filter Material --------------------.-----•----.---------_._ - <br /> Distance to nearest: Well ________________________ Foundation .----------------------- Property Line ------------------------O <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter _______________ Number -------- ------------------- Rock Filled Yes ElNo 0 <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) ------------------------------------------ <br /> Disposal Field (Specify Requirements) ___--0-_ _ ___. .0 _-- -- _- ---X 3-- <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 agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of BY <br /> Signed ------ Avnnt <br /> A -------------------------- <br /> �. - ------ ----------------------------- <br /> If of er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .___-- - ------------------------------- -------------------------- DATE -----n ,g CI�� <br /> BUILDING PERMIT ISSUED -- --- --------------------- - -- ----------------------------------------- -------DATE ------------------------------------------ <br /> ADDITIONALCOMMENTS -----------------------------------------------------------------------------------------------------------------------------------------•------------------- <br /> ------------------------------------------------------------------------------ -------------------------------------------------- ---------------------------------------------------------------------- <br /> --------•-------------------------------------------------------------------- ---------------------------------------------------------------------------------------•-------------------------- <br /> ---- -----k- <br /> Final Inspection by. ------_ ------_----_ --- -------- <br /> ----- ------ ---- -- -------- Date ".__ ,_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT r[*� <br /> E. H. 9 1-'6B Rev. 5M V°� <br />