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FOR OFFICE U.SE: APPLICATION FOR SANITATION PERMIT <br />�......-... ............................. Permit No. ..7........ /o... <br /> (Complete in Triplicate) <br /> ................................... Date Issued <br /> 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 .. _ .a. :... ..... ."�=" ................. _..........- .......CENSUS TRACT .......................... <br /> Owner's Name .........a6ty '..... -- .... ........•..............................................................Phone ................................. <br /> Address . ....... ................. City j ............. <br /> ..............•---•...... <br /> Contractor's Name - +._. �...... .. License # -. -� Phone .............................. <br /> Installation will serve: Residence ©Apartment House❑ Commercial ❑Trailer Court <br /> Motel ❑Other <br /> Number of living units:.---. ...... Number of bedrooms ...).......Garbage Grinder ............. Lot Size ..��•�t`��-�+f.� ............. <br /> Water Supply: Public System and name ....... ...............................Private ❑'� <br /> Character of soil to a depth of 3 feet: Sand ilt 0 Clay ❑ Peat❑ Sandy Loam (] Clay Loam ❑ � <br /> Hardpan Adobe❑ Fill Material _......._... If yes,.type ............................ <br /> V <br /> V <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 1 j <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 240 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK f I Size................................I............-._.- 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 <br /> _------------.------ .._.-.Distance to nearest: Well ........................ Foundation ........................ Property Line <br /> SEEPAGE PIT O Depth ._.._.__............. Diameter ................ Number ....----.-.--..._..._...--.. Rock Filled Yes ❑ No {] <br /> Water Table Depth .............Rock Size <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prey. Sanitation Permit# _..__....................................... Date .................................. <br /> Septic Tank (Specify Requirements) ............... .............................. = ........ ..................................................._....._-•---- <br /> Disposal Field (Specify Requirements) ....a:-w—d(. ......... ... .. .. 7- - �."-........ ...... <br /> a-------- 3..''. - -.5. ...-. .... ---- ----------------------.........----------�----••-••-.....--- ------------------ <br /> '�""" <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. Horne 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 California." <br /> Signed .. Owner <br /> By Title . .................... <br /> ......... ................................ .. .... .- - <br /> � <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .............. . . ..... DATE ...._/�. ....� ...� - -- <br /> .............. .---- <br /> BUILDINGPERMIT ISSUED ....................................................................................................---•-•.DATE .......................................... <br /> ADDITIONALCOMMENTS ......... .......................•-----...........---............_---...............--.....--•---.........---------......-----•..:-•--•..........---......... <br /> ........................................................................................................................................................................................................... <br /> . <br /> ....................----------...........................................................•---•..................................................................... <br /> ................................... <br /> FinalInspection by: ........................................C.4.7........................................................................Dote ..---.. .: .._ .. <br /> SAN JOAQUIN LOCAL'�HEALTH DISTRICT <br /> 717 21-7r- <br />