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I-"?IV 1-1 <br /> 1�61Z OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> --------------------------------------------------------- <br /> [Complete in Triplicate] <br /> ---------=----------------------------------------------- p. <br /> Date Issued -��--�y----� <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 - - --- -------h--C? --- ��i� _'�J_F7 :----CENSUS TRACT -------------------------- <br /> Owner's Name --------- -------Phone � 77:Y <br /> �} e -_ a- <br /> Address ---------------------- ;:_J- _e— City ------------ ------------------------------------------ -----------------... <br /> Contractor's Name ------ --- - -------- e------ -------------------------------------.License # ------ -.-------------- Phone ------------------ ----------- <br /> Installation will serve: Residence rtment House❑ Commercial:[ Trailer Court ❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:-----.__.- - Number of bedrooms ____Garbage Grinder - Lot Size ___ __________________-_______________-- <br /> Water Supply: Public System and name - -----------------------------------------------------------------------------------------------------------PrivateX <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay E] Peat F] Sandy Loam ❑ Clay Loam .� `` <br /> Hardpan ❑ Adobe Fill Material ------------ If yes,type ---------------------------- <br /> LN <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) W <br /> W <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) t <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ I Size------------------------------------- ---------- Liquid Depth --------------------,----- <br /> Z� Capacity - ------------------ Type -------------------- Material---------------------- No. Compartments ------------......---- <br /> t Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -----------------I—— <br /> -------------_______.__ Length of each line________.__-----_____._.___ Total Length <br /> LEACHING LINE [ J No. of Lines g -------------------------'- <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -----------------------------.-.----------•. <br /> Distance to nearest: Well -----------------------_ Foundation ------------------------ Property Line ________________________ <br /> SEEPAGE PIT [ ] DepthDiameter P-- Number -------I------------------- Rock Filled Yes,K No i❑ ` <br /> Water Table Deptht �i <br /> --------- ----- --- --------------------- ------Rock Size ---------------------------- <br /> Distance to nearest: Well -_�------Foundation Offer- - Prop. Line ..._13------------- <br /> REPAIR/ADDITION(Prev. <br /> -REPAIR/ADDITION(Prev. Sanitation..Permit# ------=------------------------------------- Date -------------------------------- <br /> Septic <br /> __________________-__-------Septic Tank (Specify Requirements) ------------ -------- --------------------------------------------------- ---------------------------- ----_--_----------------------------- <br /> Disposal Field (Specify Requirements) _- w ® ' ' � � _ ----------- <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, I shall not employ any person in such manner <br /> as to becomes sect t or mans Compensation laws of California." <br /> _. <br /> Signed - Owner <br /> By --.-=---------------------------------------------------------------------------------------------------- Title ------------- ---------------------------- ---------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- --.<Gem-_1----- ---------- DATE ..-�� --'�-S -- <br /> ------------------- ------------------------------ <br /> BUILDING PERMIT ISSUED --- --- ----- --------------- ----- ------------- - DATE ------------- <br /> ADDITIONAL COMMENTS P -64K 1 _ '� <br /> - -------------------------------------------------------- ---------------------------------------- - --------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------/� ]_ <br /> ----------- <br /> -------------------- <br /> --------------- -- ---------------------------------- ------------ <br /> Final Inspection b --------------------- -------------------------------Date --- 7 <br /> V 3------------------ <br /> SAN �OCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M �/� <br />