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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. .7...... ........ <br />.......... ........••--•...._....--•..... ....... (Complete in Triplicate) (P-'7S <br /> ............................. . This Permit Expires 1 Year From Date Issued Date Issued .J.:_...._........... <br /> ............. ..............................._...... <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 /> (7.11��.............cENsuS TRACT ............._..__.._... <br /> ----------­- <br /> JOB ADDRESS/LOCATION --S --••- -- <br /> - r -' ;Phone .................................... <br /> Owner's Nome . may,° --•-----• •�"-' <br /> Address .... City <br /> - �=• ' <br /> Contractor's Name '�' ----------------- License # _.- f..+l Phone ..�..: <br /> Installation will serve: Residence Q'Apartment House'(] Commercial'[]Trailer Court 0 <br /> Motel (]Other _...._............. ................ •-•••= P;.T---- -•---.. <br /> Number of living units:_........ Number of bedrooms ... 4:--Garbage Grinder ... Lot Size --__ - <br /> Water Supply: Public System and name -----•-•----- ................ -...--•-----.--.-------•-••--------------_.._... Prwa ' <br /> to <br /> "'Character of soil to a depth of 3 feet: Sand .Silt E) Clay Peat j] S:dy_Loam ❑ Clay Loam [] <br /> E Hardpan [J Adobe E3Fill Material _........... If yes,type --'.-.-------- !� <br /> (Plot Ian, showing size of lot, location of. system In relation to wells, buildings, etc. must be placed on reverse side.) S � <br /> p <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if Oublic sewer is available withGn 200 feet,) <br /> " _ Size__._.'/r _-- - Liquid Depth <br /> SEPTIC TANK ............. •........ <br />} PACKAGE TREATMENT ( ] f l' <br /> _ F ,� _.. <br /> Ca oei . __ i '� -.. Material. ��:.�✓' No. Compartments ... <br /> p ty .���{�__.... Type ...... t ....... <br /> ------..Foundation �� ...F._ Prop. Line <br /> Distance to nearest: Well .��(1.__----•- .._. ..-----• ..---"'.............. . <br /> LEACHING LINE No. of Lines ..__ -_.t....--_--. Length of each line----- .............. ngth .__.--�.... OV <br /> Total Le <br /> [ ] - _ � -- De th Filter Hlater'ial' <br /> P <br /> ':.�_ Type�'Filter Ma�rial ---�--••---•--• .. .............. <br /> II 'D' Boz`? . -••- •= ---- <br /> r� i'6 Pro a tiny -�-....... •...... � <br /> Distance to nearest: Well ------ ---------••--- Foundation ...__...__ ....._---- p ffY`, <br /> a:. ,:_-•_--::Rock-:•Filledy Yes g' No Q <br /> SEEPAGE PIT ( 1 Depth .. _ Diameter �..�.�.:�. Number .._.--------...._.. . <br /> 0 <br /> Water Table Depth Rock Sixe ................................r <br /> i Distance to nearest: Well ............... ._-_Foundation .................... Prop.. Line --------- ------- <br /> 'i <br /> �#` <br /> REPAIR/ADDITION(Prev. Sanitation Permit ..........•........__..................... Date _-__.... ---------------------- E <br /> s <br /> Septic Tank (Specify Requirements ........................ F ....... - <br /> Disposal Field (Specify Requirements) ...................... ...•--•----_......._....._._.....�. <br /> • -I. - - - ---••------- <br /> ..«- .F , <br /> - I <br /> i -k - -- -------- ----•-----..._.... ............................. <br /> 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 Dist iect. Horne owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performancer of the work for which this permit is issued, 1.4h not employ any person in such mannas <br /> j <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .. ----------- --------------- ----- Owner <br /> By f � C ..._. 4. •-- ..... Sitle,........... ...... Y <br /> (If other than owner) " l <br /> FOR DEPARTMENT ISE ONL ,, <br /> APPLICATION ACCEPTED BY ---_ ....... .... _ _________ <br /> DATE . ... - ...--•..._... <br /> BUILDING PERMIT ISSUED _... .--- ..-. •--------•-----....--•.............I.__...........DATE ...... _.::::.. ......--- -•-•.. <br /> ADDITIONAL COMMENTS ............. .... --..._......_--••--......__.._.._...__.... -•-•......_._....-....-•...------•- <br /> ...--,---....__•-- ..-.................................... <br /> ••••................... ........ ..........................................................Date .................` .-.� ... <br /> Final Inspection by: - - - .................................................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />