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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit <br /> (Complete in Triplicate) Perm -- <br /> ------------------------- _..��- <br /> Date Issued._ <br /> ............. <br /> .............................. ...--------.....-- This Permit Expires ] Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a�permit to cori9truct and_install the work herein described: <br /> This application is made.in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> �/ l 1�1 ......._...CENSUS.TRACT. <br /> J08 ADDRESS/LOCATION- /��.�.�''" --':✓1.�.... �. ----���----�... ----�-- •-- -- ---- - � �-,-,� � -- ............ <br /> ~/ r Phone.--.. y... <br /> Owner's No .- '.. �► /4! .. !--t�7 i�,-l.�Q�: !¢.. ..._ " i <br /> -- ---. . <br /> 4 5s <br /> Address ---_........................ Ci ! !{ --- --- <br /> Contractor's Name.... _ --. ... 12 % <br /> — . ............ ...................................License #�� ..Phone. .--- ------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial 23.-�railer Court ❑ <br /> Number of living units:............. Number of be ms___- Garbage Grinder.-._---_.-._L} . <br /> Motel ❑ Other---..._..------.. .... -------- <br /> --- --.ot Size---------------...:� . .... _...-,----=---• .....".. ._ � <br /> Water Supply: Public System and name....... ...:......... ---.4j'...----------- - ----------------------------- Private <br /> Character of soil to a depth ofp3 feet: Sand ❑�il�Material., <br /> Peat ❑' Sndy Loam.❑ Clay Loam ❑ r.., <br /> Hardpan Adobe Y type . <br /> F � <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 septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ( ] Size _ ------------------------------------"--- -------..Liquid Depth._----_..-.-- - "- <br /> Capacity...... ........------Type--• ........... .....-Material . -- --- -.--- --. _...'No. Compartments----- -----•---- - <br /> Distance to nearest:,Weli .................................Fo nd tion------- <br /> ..... ..Prop. Line............... V <br /> t Total Len ... -------LEACHING LINE [ ] Na, of Lines Length of each line.-..... ...:.... ......... .. Length ... <br /> Box...._r_ _ Type Filter Material/ th Filter Material.. '.,- -...___-- <br /> Distance to�res W 11 / ..__ Foundation________________ Property Line................. <br /> SEEPAGE PIT [ ] Dept*-_ iamet .� I-------- Z"'NNall <br /> - <br /> -" umber....________ _ ..._._. Rock Filled Yes_ o <br /> y <br /> Water Table Depth._---------------------------- - ----------- -----------Rock Size-.:- <br /> Distance to nearest: Well...-............ Foundation............ Prop. Line..___.<:.:.:........... <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.._..._....._ - <br /> ] <br /> Date... ......:..' -::_ . . a_ ---- <br /> ------- ------- <br /> __ <br /> ------ -- --- ------- < . <br /> f . . _ -------- <br /> y Requirements). <br /> Disposal � <br /> Field [Specify Requirements)....... ...._ <br /> -_----:.-----•--- -------------------..-------------: • .._..---- <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 County <br /> Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: i <br /> "I certify that in the performance of the work for which this permit is,issued, I shall.-not empfyany person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> Signe Owner <br /> By..._ .. ------ ... Title.__._._..-�'�✓"------- <br /> --------------------------------------------------- <br /> (if other than owner) i <br /> F R DE RTM LI ONLY <br /> EF OP F ff <br /> APPLICATION ACCEPTED BY- -- - ----- -- --- t! Z.. DATE ...S.'. _. .fir... <br /> DIVISION OF LAND NUMBER.............. - ---•--•-----------"........DATE----.----..""-----. <br /> ADDITIONAL COMMENTS. k-L, <br /> ................ r ( J�r..... . ..s=z`. ... .. - -------------------------- .- ........ ...--- <br /> ..-----•------------------•-- --- --- ..................... -------------------• ----------------- <br /> ------------------------------------ -- ' -- ---- <br /> Final Inspection by - ....Date.---6-�-��`7 <br /> Ell 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F s lien Rev. 7��6 3M <br /> J <br />