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FOR OFFICE USE: APPI.ICATiON FOR SANITATION PERMIT �S <br /> ... .... . . . ......---- Permit No. . 7 <br /> J (Complete in Triplicate) .............. <br /> This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No, 549 and existing Rules and Regulations: <br /> �J <br /> JOB ADDRESS/LOCATION ...........: �� =..-•-� <br /> . ..�P <br /> CENP�S TRACT <br /> � - ......••----• -•--------•• .. one ` ..3./�O"r"s Name <br /> Address ........ . .... ...:...... ..^... .. City ................................ <br /> Contractor's Name ....` .--------• •-.....----.•. ..:.License # Phone r� <br /> " <br /> z ' <br /> Installation will-serve:--- — -ResidenceApartmenfi House•❑-•Commerclal (-]Trailer Court 0 <br /> Motel ❑Other --------.......................•-••--------- W <br /> C� <br /> Number of living uni#s ._,- <br /> /.....- Number of bedrooms ....:....Garbage Grinder ._____.___. Lot Size ..................................----...... <br /> Water Supply: Public System and name ....................................----------------- ----........._.•......•................ ----............Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe'p 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 septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> .PACKAbE TREATMENT ( ] SEPTIC TANK'1 1 `"� . Size_________________________ • ------- Liquid Depth ......._------ L..... .r <br /> CapacityYp ' R 1 .. 9 <br /> ..,.---•------------ Type Materiai---------------------- No. Compartments ----=-•---_.:......... <br /> t <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line ......... ......__--.. <br /> }. 1T1 <br /> LEACHING LINE [� No, of Lines ........�______------- Length of each fine.___---x`�_ ..... Total Length ._._f _...--......... ' <br /> f /47€..........................i <br /> 'D' Box _.-_5------- Type Filter Material .__.•-�..l�...._Depth Filter Material ...........:........ <br /> _.�__---- Property Line .... ...._. <br /> i <br /> Distance to; nearest: Well ...__.. ..... Foundation yl. . • -•--•••--• <br /> SE ErPAGE PIT Depth ----- : —�:. -Diameter. . .. Rock S Rock Filled Yes ® No ❑ <br /> p '._. Number ,1... <br /> Water Table Depth ................ .............. ire- = .1..._.......... <br /> , S i - . C. r — .1 le ! r <br /> +t' _;. Tyr- - ._ .� J. <br /> Distance to nearest: Well'__._:_,,1000......................Foundation ...._ Prop. line .f.��2.._... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date .......:........................... <br /> ) <br /> Septic Tank (Specify Requirements) ----.....................................-------- _------- ......_... :-_.-.......... -...._... - <br /> _ r� <br /> Disposal Field (Specify Requirements) .......... , _!.......... <br /> .. �. -tL. ----�`� �. •� - <br /> r <br /> ..........-........................................................-__----..........-----------------------------------.......-•........... ............... --------_ ........................ <br /> � df <br /> --------_---._.________.................-_._.... <br /> ._._.____.._...................._.__.-_._.____......_._._.._..._.._....�...........________. <br /> (Draw existing and required addition on reverse side} l <br /> 1 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 District. Home owner or licen- <br /> sed agents signature certifies the following: _Y �--" <br /> "I certify that in the performance of the work for which this permit is issued, I shall_`not enn,ploy any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> a <br /> Signed `---- ------------•------------..-••- •--------•----------•- -••------------ Owner r . <br /> Y <br /> B '.......... _ t1'......---•..--.. Title ..__C /��- .................: <br /> j (If other than owner) <br /> FOR DEPARTMENT USE ONLY { <br /> APPLICATION ACCEPTED BY ... ....__. . . DATE ..... ..I <br /> BUILDINGPERMIT ISSUED .... .. •-•----•...............•----..•._...-----------------•-•-----• ..................:............._DATE _..__.............._.. <br /> ADDITIONAL COMMENTS ................................__........------------------•-----•-•-----. ........._..-----................ <br /> -----------------------------........_........._-----•-----•-- --.-..._-..---•------ <br /> ........................................................... -------.—........------------ ---- ----- ............................•-................ ............... <br /> .o <br /> --------- <br /> ------------------------------------ S <br /> ' Final Inspection b ..Date . --------------- <br /> _ SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7119 A u <br />