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rvx vrrrc.e uze <br /> APPLICATION FOR SANITATION PERMIT <br /> ....................................................... (Complete in Triplicate) <br /> Permit No. ..7 2. .,f.Z. <br /> ............... ........................ ............. This Permit Expires I 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 made In compliance with County.,Ordinance No. 544 and existing Rules and Regulatlons: <br /> .JOB ADDRESS/LOCATIO .. ..�. . CENSUS TRACT ... / ..... <br /> Owner's Name :a. ......, ?�. ........I......... ........................................................Phone f xx_.4�1.Z,l......... <br /> 1-�.�<. ... . . <br /> Address . ... *... ............City ......... .... .. .. ............................................. <br /> Contractor's Name _. .... <br /> ........................................... <br /> license '�•�a .... .... Phone __�, lm� e r <br /> Installation will soave: partmentHouse t] Commercial!]Trailer Court C <br /> Motel❑Other----- ...................................... <br /> Number of living units............. Number of bedrooms _.....Garbage Grinder ...._-_----- Lot Size -_----_----._--.___...__..............._.... <br /> Water Supply: Public System and name ...................................._..__-_---- _ - ......................................Private �- <br /> Character of soil to a depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ . <br /> Hardpan❑ Adobe❑ Fill M6terlal ............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 public sewer is available within 200,P,09 <br /> PACKAGE TREATMENT [ ] -SEPTIC TANK Q/''�Y Size........................................... ... Liquid Depth ......................... t <br /> Capacity& pe .. ........ _.. Material.....:........ No. Compartments <br /> Distance to nearest: <br /> Well ... d..._-.-. ' Foundation.-ld.... <br /> .. ......... Prop. line- --.......�---- <br /> r <br /> LEACHING LINE [ ) No. of lines ................... Length of Jach IIAO..7 J.................. Total Length .1.a................ <br /> P J <br /> 'D' Box _/........ Type Filter Material .....Depth Filtetr Material <br /> ............................................ <br /> Distance to nearest: Well ........................ Foundation ..._..--_.-- ......... Property Line .............:......... <br /> SEEPAGE PIT [ Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No <br /> Water Table Depth _........----............................_-----Rock Size ................................ <br /> Distance to nearestt Well ....Foundation .................... Prop. line <br /> REPAIR/ADDITION(Prev. Sonitotion Permit <br /> ................ ..................... Data ........ --.._.........._ .I <br /> SepticTank (Specify Requirements) -----•................................... .: ...........................•--..............---...._........_.............................. <br /> Disposal Field (Specify Requirements) ..................................................................................................................................... <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, Slate Laws, and Rules app liegulatlons of the San Joaquin Local Health District. Hence owner or lie*n- <br /> sed agents signature certifies the followlAg:` v <br /> "i certify that In the performance of the work for which this permit is Issued, I shall not employ pity person In such manner <br /> as to become subject to Wojkman's onipensation lows of California." <br /> J� -^ <br /> Signed ...�c,��...�.... .._: _ .._..�...-.-•=-•--••--------------------•-••--•--..... Owner <br /> �� ....................--.. 7itle ........................................................................ <br /> By ............................... t l ......:........-..-....-.. <br /> IN other than owner' <br /> FO DEPARTMENT USI"-ONLY <br /> APPLICATION ACCEPTED BY ... ... ..... - <br /> BUILDING PERMIT ISSUED ..................... ................................................................... .. .......DATE <br /> ADDITIONAL COMMENTS <br /> r ........................................ ------------------------------------------------------------------------ --------•-•.................. ....... .................................................. <br /> ..................•---......-.- <br /> ......................... . <br /> final Inspection by: ....... c ....... Date .. .. <br /> EH 13 24 r6fl Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> J <br />