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FOR OFFICE USE: I APPLICATION FOR 'SANITATION PERMIT <br /> - ------------- -------- -•------=------------- . �- ---� <br /> (Complete in Triplicate) Permit No: <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 aq install the work herein <br /> described. This applicati n i' made in compliance with County Ordinance No. 549 and existi I u&Sd'1iEegulations: <br /> JOB ADDRESS/LOCATION , --G�� j �f----- -��-�ad1L `- ----�-- --- SUS ACT ------------- ------- <br /> Owner's Name /��f�l �` �J-- �'' --------------------------------------� -- -- - Phone . <br /> :k <br /> Address __p ------ - - 1?a "-------------- - # <br /> City _ ' + -� '------------------------ _ ' <br /> Contractor's Name -__- ----= �� ---------------------------------License #` -:� Phone _-„2�1 <br /> Installation will serve: i Residence Apartment House❑ Commercial ❑Trailer Court <br /> Motel ❑ Other -----------------------------: . .----:- <br /> Number of living units:-__. -__ Number of bedrooms �1�_______Garbage Giinder��� Lot Size�� -------------------- <br /> Water Supply: Public System Land name --------------------- " ------ ------------- # Private <br /> a �--------------- X <br /> Character of soil to a depth, of 3 feet: Sand Silt0" Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> i Hardpn Adobe ❑ 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 INSTALLATION: (No Iseptic tank or seepage pit permitted if public sewer is available within 200 feet,) ' <br /> PACKAGE TREATMENT [ ) SEPTIC TANK Size ___________________ Liquid Depth -_ <br /> C p city=l t =�TYp =4n Material_ --� --------------- <br /> Distance <br /> ------� <br /> I I ` lij N` Compartments - _:____ <br /> Distance to nearest: Wellaf-t.11 __-_-______r�� 1P____-_--Foundation /._r2________.____ Prop. Line%�f_'__ ______ <br /> ii <br /> LEACHING LINE ] Nfo. Io f Lines -.�.- _--_ _ Length of ',eac' line__�� �' __.._. <br /> - __-- _-- Total Length a�.- +AV�_..-.------- <br /> Type <br /> ____-- <br /> } D' B�x _ T e Filter lUlateiai � '4Depth -Filter, Mafenaf f --------•----------------------•- <br /> --- -.-- FoundationQ -,__-: i <br /> ii 4 Ili Well �8-_-- / i �"` 'Property Line, l-- - - 4 <br /> Distdn a to nearest � � <br /> SEEPAGE PIT [ ) Depth -.---_-------_____I Diameter ...-_-______--- Number __________ Rock Filled Yes ❑ ,)No <br /> .i Water Table Depth ______Rock Size !____________________________ <br /> Foundation I-------------------- Prop. Line ------------ <br /> $ y Distance to nearest.-Well __._..______________________--'_-- �--=--•---• <br /> II 1 ---------------- Ddte -----•-- <br /> -------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _____________ 3v � �---_-----___-__-_--_-) <br /> • IM 1 <br /> Septic Tank (Specify Requirements) ---------- " ------------------------------_------------- '---------- <br /> •. <br /> Disposal Field (Specify Requirements) ___ -____-__ y <br /> s <br /> ----------------------- <br /> # i <br /> -------`,-�- ---- ----------------------'I--- - ----- --(Draw existing and required addition <br /> - - - -' - -------- ----------------------------------------- -- -- ------- <br /> l r 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 /> sF 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 /> �f 'I certify that in the performaince of the work for which this permit is issued, I shall not employ any person in such manner <br /> ..has to become subject to Workman's Compensation laws of California." I <br /> w;'Signed'-------- ------------------- - ° Owner I <br /> }. -- - ---- ----------------- .� <br /> II y��y,, <br /> BY ------ -- ; Title 'f / �L ---------------------------- ; <br /> (If other n owner) <br /> 5 <br /> FOR DEPARTMENT USE ONLY L' , <br /> APPLICATION ACCEPTED BY _ 7/Le_ ±t�------------------------------------------- - --J-----------`----. DATE�I_"' S '�' ----------------- ------ <br /> BUILDING PERMIT ISSUED ---��=-----------�------ -------------------------------------------------------0----=----- -I------DATE -------------------------------------------- <br /> ADDITIONAL COMMENTS .---iO F <br /> -------- ----------------- -------------------- ------ <br /> ---------------- <br /> -I= ---------- ------- <br /> ------ ---- <br /> ------------------- --------- === ------------------- ----- -- - -- ------- ------------ <br /> --------------------------------------------------- <br /> Findl Inspection by `�� = <br /> �-��-_ /-------------------------- _ Date �' ;y <br /> SAN JOAQUIN� LOC'l�%"-,iEALT!-i-RlSTRICT <br /> E. H.'9 1-'68 Rev. 5M 1 <br /> �'.t � S • ��4 ;i. A <br />