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>OR 6FFICEFJSE: <br /> APPLICATION FOR SANITATION PERMIT �. <br /> (Complete in Triplicate) <br /> Permit No. .. <br />......... .......3........'"......................... .. 1111...... . <br />.................................. . . Date Issued . - S.Z. <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 comp - rcewit Cpunty Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCA <br /> T .-- <br /> - �-� <br /> f 1111 CENSUS TRACT .. <br /> Owner's Name ........ .... ...... r <br /> 1111 qq� <br /> ----- <br /> - <br /> hone,... .. ..51 <br /> Address <br /> /.� C <br /> .............. City <br /> ....... ...... „..........._ <br /> Contractor's Name .. :•-- ,- - -----.License # .-...--....11_11- ---. Phoney.. �� <br /> Installation will serve: Residence KApartmen2ouse0CommercialTrailer <br /> ❑ Court ;❑ <br /> Motel ❑Other .........111.1- - ........ <br /> Number of living units:.. .1...... Number of bedroo s . <br /> .3 9' <br /> h7 �...Gorba a Grander ...--1111... Lot Size .... ...............�.-- <br /> [,� --...------1111. <br /> Water Supply: Public System and name ....................... • -_ _ _ .__ . <br /> ---------------------- Private C3Character of soil to a depth of 3 feet: Sand❑ Silt Clay ❑ Peat E] Sandy Loam [] Clay Loam ❑ <br /> - <br /> Hardpan ❑ Adobe Fill Material - If____ _ + • _ �..., yes, type ................. <br /> (Plot plan, showing size of lot,-location of system inf relation to wells, _ <br /> Y buildings, etc. must be placed on reverse side., <br /> NEW INSTALLATION: {No septic tanI f r ' 99 <br /> 'kror seepage pit permitted if public seweF is available within 200 feet,) <br /> PACKAGE TREATMENT ,� SEPTIC T f � U Liquid Depth ..............•--.-.-- <br /> NK l Size ------..- ..A"/Ja .... <br /> Capacity . . Type -------------------- Material.....-.- - No. Compartments <br /> .. ....:........11 ...... <br /> Distance to near st, Well <br /> -------_------------Foundation ............1111....... Prop. Line -----------_--_-1111 � <br /> LEACHING LINE <br /> _ [ ] No. of Lines Length of ach line . 1111 . Total Length <br /> -. .... .. . .... ............1...----•------� <br /> ;D 'Bax' - . pe Filter Material ---------- 1111.. . epth: Filter Material -1111-._.- ' <br /> -----------*.................... <br /> Distance to riearest'�Well --------- ._...._.-- Fou tion Property Line <br /> ...._.... <br /> SEEPAGE PIT ( ] Depth -- Diameter umber Rock Filled Yes ❑ No 0 <br /> �...� 1111.-----•• - --.. . <br /> Water Table Depth ... ...............------------- .. <br /> ......_..ROCK Size.. --- <br /> Distance to nearest: Well ....---------.......... <br /> -- _-•...........FbV*ndation; ---___.......... Prop. Line ...................... ! <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- - ............... .......... Date ----------­-­ <br /> Septic <br /> .,__----. - .Septic Tank (Specify Requirements) <br /> --..........------•.............................. <br /> Disposal Field (Specify Requirements) <br /> •--------------------------•---- ----•---1111--.-------------..-...�-- ..........._.......- � -- - <br /> --••---• ----1111---- - ------------ �.-----•---• .. ---1111..---•----�..----...-•--- <br /> ------------ .. ... ........._......._......... <br /> 111.1-11...11. .--1111---- ...... ....... . ....... ...... ... ................. .................... <br /> (Dra'w existing and required addition on reverse side) } <br /> 1 hereby certify that I have preparedthis 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 p y an y person in such manner t <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed1111 . ... ........ .... ...... ------....----- --------- Owner <br /> By . /.. -----.--- . Title . 1111 <br /> -1111.-1111---------- ----------- <br /> . ......-1111... .._ 1111. -- .. _................... <br /> oth�h . ner may' <br /> y _ /fOR a PARtMENT USE ONLY � <br /> APPLICATION ACCEPTED BY ...C- .. DATE 7- <br /> .. <br /> `� <br /> BUILDING .PERMIT ISSUED .............. . <br /> -- ... ...- --........... . ......... . .1111...-. <br /> .. .... ... . .... ------- ------------- -- DATE ....--- <br /> ADDITICSNAL COMMENTS .--- - <br /> ....... -•------ .............. <br /> ------------- ------------ ----------------- <br /> --------- -- -- ----- --- ...•--••---1111..--- <br /> . --- <br /> -----•---1111.-. --� - --• <br /> ---------- --- ------ - -Final Inspection b •--�---• --.<. 1111---- ----•----- t <br /> --•--- " i ----------- .--.-_ ......Date . <br /> - 1111. ..... .. ............._.........--- <br /> SAN JOAQU(hF' LOCAL-HEALTH 'D15TRICT <br />