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rvx Urrt%x vac: <br /> APPLICATION FOR SANITATION PRRMIT <br /> •.............................................. <br /> (Complete In Triplicate) <br /> Permit No. . .............. 1 <br /> ... .. . .......................................... Date <br /> This Permit Expires 1 Year From Date Issued <br /> Application Is hereby made to the San Joaquin L Health District for a permit to construct and Install the work herein <br /> described. This application Is made in complion ith County dinonce No. 5 9 a d lxl�g les and Regulations <br /> { <br /> 109 ADDRESS LOCA N .. .. .._.. ._. _ �-..... .. .-•- - - •• ...Ar.- - --•---..._..__...r.......�.............CENSUS TRACT .......................... <br /> { <br /> i .PFion`1.:���.1/.V... <br /> Owner's Nome .. .. f......................................... ...... 7.... <br /> <%ddress ........-� .�...- - :... 1 ............. ............ .. ... .............City - :� ........................•....................... ......... I <br /> Contractor's Name -• ----• •--•• __-._. ..... L...........License dE,A!-N_��..�sa�... Phare . ..... <br /> installation will serve, Residence Apartment House] Commercial❑Trailer Court ❑ <br /> I <br /> Motel ❑Other <br /> Number of living units:./...... Number of bedrooms �......Garbage Grinder ............ Lot Size .:...... . ...................�� <br /> Water Supply: Public System and name . -•............................w_..............._...__......................................._.,...••••.Private V <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 day Loam ❑ <br /> Hardpon-j Adobe%L 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 ublic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK e.... ..._�_ .Q.�........................ Liquid Depth .9-�.._. ..--•. <br /> Capacity �_D10.._... T L4!z?'-.. Materlall.�wa.&.._ No. Compartments ...!2............. <br /> P tY YPe <br /> Distance to nearest: Well .Foundation l4P . Prop. Line <br /> :.EACHING LINE No. of Lines .- ............... Length of each llne..... -�......-... Tota! Length ....l.�l�...�....... <br /> T 'D' Sox .. . ..... Type-Filter Material, c .....Depth Filter Material ... ............................ <br /> Distance to nearest, Well . ..i .`....... Foundation .. ....Za....... Property Lins'Jr..l :�• <br /> SEEPAGE PIT Depth .. ... Diameter,?Jf�.... Number ..+,` ..........�..�t.. Rock Filled Yes No ❑ <br /> Water Table Depth .........t . ...................Rock Size _.f��..0_ �,��.... <br /> 10t <br /> Distance to nearest: Well ....,f4d .r...................Foundation ,_..__.... ........ Prop. line ...... <br /> REPAIR/ADDITION Wrev. Sanitation Permit# ............................................ Date ..................................I <br /> SepticTank [Specify Requirements! ........................................................_........---••-...................................._........_....................... <br /> D;sioosal Field (Specify Requirements) ...........................................•......----......................._............---...............................---...... <br /> .................................-•----•-----------.................__.....--•--------...._......--•---.......,_.__......-•-•-•••...........----...._.....................---...I...........-•----. <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 dons 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 pe rmance of the work for which this permit Is Issued, I shall not employ any person In such manner <br /> as to bete a sub act t orkman' Compe satlon laws o California." <br /> anec� f�i` ..�.......i.... ._ ,_.3C .. = -• - Owner F <br /> BY . ... .......................................................... . . . .....�------ ---- title .... ... _ .... .... ._ .....-............................ <br /> lif other than owner) - <br /> R D PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... .............. ......_..................................----....... DATE ..... 7.'"'- - ......_'. <br /> BUILDINGPERMIT ISSUED ....................... .......................................... .......................................DATE>..........._..........._..-.....-.......... <br /> ADDITIONAL COMMENTS ..................................................... <br /> ........Date <br /> Final Inspection b <br /> - 7'.. ........... .................. <br /> EM 13 24 1-68 ilev. 5K SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />