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FOR OFFICE 115E: <br /> APPLICATION FOR SANITATION PERMIT <br /> µ 7� <br /> I <br /> (Complete in Triplicate) Permit No. .--�._.._.�....... <br /> Date Issued <br /> ---•..................................................... This Permit Expires 1 Year From Date Issued <br /> I 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 ................' ---- ... /.._ ....... .......:..............CENSUS TRACT . . ...... --------------- <br /> Owner s Name <br /> M...... <br /> f ..,........ ...... ...........Phone _..�v13-- X� <br /> ' Address ......... 1?c: q Gll..-----........------...._._........ City J 1✓i G ........................................... <br /> Contractor's Name ...._...... �. -F-a-1-1-1-5-P-F-a-1-1.1-_m----.---••- :..............License # Phone <br /> f Installation will serve: Residence R Apartment House C] Commercial ❑Trailer Court 0 <br /> + Motel ❑Other .........I......­._....------ ------ <br /> Number of living,units::., /,,•...: Number-of-bedrooms _,3......Garbage,.Grinder-,:.-._...:.__Lot Size ......... <br /> I Water Supply: Public System and name .....-•-------•-------------------- .. -- ------•----- ---- •---... . .....--------------1....Private ] <br /> + Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loom Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ......... If yes, type ... ............. <br /> (Plot plan, showing size of lot, IocotioWbfYsystem 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 /> f PACKAGE TREATMENT ( ] SEPTIC TANK{ ] Size---------------_--__........_................ Liquid Depth ...............--......... � <br /> Capacity .. . ....... ...... Type ... ...... Material.............. ....... No. Compartments -------•--_ ......... <br /> 1 Distance to nearest: Well ....................................Foundation ........._.._........ Prop: Line ................... <br /> LEACHING LINE [ ] No. of Lines Length of each line. ........ .......... ...... Total Length ....---------............. <br /> _. <br /> D' Bax .._- . Type Filter Material. --.------.—.,:..Depth Filter Material ...................................... <br /> ...... <br /> V <br /> Distance to nearest: Well ......................:. Foundation ---.-----------......... Property Line .............. <br /> SEEPAGE PIT [ ) Depth Diameter ............. Numbe,......._.. .I--._-....... Rock Filled Yes ❑ No 0 <br /> Water Table Depth -------- ..........__------------------------Rock Size ........ - .................... <br /> Distance to nearest: Well _......r.................................Foundation .............. ._.-- Prop. line ..... ............. <br /> REPAIR. ADDITION(Prev. Sanitation Permit'# --------..--.-.�!- --------------------- Date ...:----------_---•---.-----•--•) <br /> Septic Tank Requirements) r,=--......-.16�e�?-... ��Z 1 % ----.-.l.rq/l!,. .................. <br /> Disposal Field (Specify Requirements) f;'...................... ............__........ <br /> 01 <br /> ................. ........................... --- �� 'Ct 1� X.,y.>C../�._.----- -< --------------- ............... . <br /> ............. . �.... -------- ------ ------ '...------ -- <br /> (Drdw existing and equired addition on reverse side) <br /> I hereby certify that I have prepared this applicotian .and that :the -work will be done in accordance with San Joaquin <br /> } �._,: �. <br /> County Ordinances, State laws, and Rules and Reg�,gym lat:_ionssof the San .I6quin Local Health District. Home owner or Jim- <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 /> fas to become subject t Wor an's Compensation-laws of Calif*nia.' <br /> Signed } OW, <br /> ner <br /> BY Title <br /> - <br /> k ' <br /> If other than owner) ! <br /> - ------FO-R�DEPAR_.TMENT USE ONLYa-_' � ..T....._. <br /> -. ,_......APPLICATION ACCEPTED BY ..... . ..... . . . :.......... ........ .�..... - - ....... DATE . � <br /> BUILDING PERMIT ISSUED ....,�.- ._----- ------------- --•--- DATE _ ........ <br /> .._.. <br /> ... <br /> ADDITIONAL COMMENTS -- -- --- ------------------------------ ------ ------------ ........................................ P <br /> --- .....---------•--.....------............_.... <br /> i ............ .•----------------.__---------------- . •-------...-- ....---- .-----...-------------- ---------------__- -------- ...........-......... .......__.......... ........................ <br /> -•-•-------- . ---•--•----------------- p <br /> Final Inspection b <br /> -....-- - ---._.Date ............... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ' 13 24 1/723 ,14 <br /> t '. E. H. 1-'b8 Rev. 5M <br />