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FOR OFFICE USE: a <br /> APPLICATION FOR SANITATION PERMIT <br /> ...............i Permit No. .1�715 <br /> (Complete in Triplicate) .................. <br /> ................ ...........m........­........ This Pormilt Expires I Year From Daft Issued Date Issued <br /> Application is hereby made to the Son 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/LOCATi9o� ...._.W/__7f <br /> ... ...._ T.`.....-. 1........` ...................................CENSUS TRACT ......... <br /> Owner's Name ....... .. .. ..... ........ ..... ....... . .. .... .. .......... <br /> Phone .... ............................... <br /> Address .. .... .. 0ty ................................................. . <br /> 1ice <br /> ni Phone .............................. <br /> Contractor's Name ........... <br /> Installation will serve. -I <br /> Residence(3 A,partment.House.C] Commercial JgTroller Court 0 <br /> Motel [3 Olher ....................................... <br /> Number of living units:.:r=.... Number of bedrooms _....Garbage.....Garbage Grinder-................Lot.Size ............................................ <br /> Water Supply- Public System and name .........................................................._.................. ................................Private <br /> Character of soil to a depth of 3 feet. Sand E] Silt.0, Clay 0' Peat n Sandy Loom M111", Clay Loom <br /> Hardpan 0 Adobe Q 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 /> . --- ­ - i <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK I Size.............•______.._------__•------- Liquid Depth ...........................6' <br /> Capacity _------------------ Type .................... Material..... ................ No. Compartments ......................_J <br /> P <br /> Distance to nearest.. Well --------_----------•...............Foundation ---__-_•--.........._. Prop. Line .___...................1 <br /> LEACHING LINE, No. of Lines ----------- ............ Length of each line--..._.._-__...-.___........ Total Length ... ........................ <br /> rp <br /> 'D' Box ....... Type Filter Material ....................Depth Filter Material .................... .......I............. <br /> Distance to nearest: Weft .................... ... Foundation ..... .................. Property Line ........................ <br /> SEEPAGE PIT Depth -------------------- Diameter ........ ....... Number ..__.._._-___--•_........... Rock Filled Yes Q No QE <br /> Water Table Depth -----------_ ---------------------------------Rock Size ................................ .L I <br /> Distance to nearest: Well ..........................::............Foundation ----------_-_4.....,Prop.-Line —..................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date __________________________________j <br /> Septic <br /> ...........__---_------_-- <br /> Septic Tank (Specify Requirements) ...................... ...................... ... .. . .... ....... ............................. <br /> Zs sal eld (Specify Requirements) <br /> ---- -- - - ------ -- <br /> ----- - ----- ----- --- <br /> - - -- - <br /> ---------------- --------------------- ---e-�------------------------ ------------------- i_ ---------------------------------- ....................................................... <br /> (Draw existing and require 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 Son 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 become subject to Workman's Compensation laws of California." <br /> Signed ------------------------------------------ Owner <br /> r~wBy _------------------------------ �a6 <br /> ---------- ----i-----X............ Title ---------- --------------- ---------- <br /> Of other than owner) <br /> FOR DEOARTMENY USE ONLY <br /> APPLICATION ACCEPTED BY_----------61-- ------------- -------- -------------------- --------•------- DATE <br /> BUILDINGPERMIT ISSUED ----------------------- ­_----------_--------­ ----------------------- -------­----- -------------DATE ......... ------------------------- ...... <br /> ADDITIONAL COMMENTS <br /> ........... ......... ......... ------------------ -- --------------------------------- ------_- --------- ----- ----------------• --------- .... ........ <br /> ........................_--------------------- ...............................6-1--------------1------- ............ ......_......................... <br /> -------------- ----------------------- ------ <br /> W'----------------------I—'------11------­­-----------------­­............ ....... <br /> FinalInspection by: ............. ------------ -------------------------------------------- -------------------- --------.-Date ........ <br /> EH 13 2h 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT B/7 3M <br />