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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - = <br /> F permit Na <br /> KCompleto In Tdplicatel <br /> ..................................................•-........... _ <br /> 1 <br /> p Dote issued 3 <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''!here€n <br /> described. This applicotion.ls made in compliance with County Ordinance No. 549 and existing Rules and Regufotions: <br /> JOB ADDRESS/LOCATION �-••.... .......... ..........CENSUS TRACT .. .....:... <br /> Owner's Name _ 1 • , + <br /> ........................................ ...... <br /> Address /......... � .. _...... --•-•-•...--- City ...... .... ...................................... <br /> ........... ........ ....... <br /> Contractor's Name ' . ........ _....License ,.. Phone <br /> Installation will serve: ResidencegAportment Housea Commercial OTraller Court <br /> i° i <br /> Motel❑Other <br /> Number of living units:........ _.- Number of bedrooms Garbage Grinder ............ Lot Size 70 # <br /> Water Supply: Public System and name ` ....................................................._.. ..................... ................. ..Private...... <br /> .... <br /> Character of sail to a depth�f 3 feet: Sand b Slit p Clay ❑ Peot.Q Sandy Loam.Q Cloy Loam ❑ <br /> Hardpan 0 Adobe Fill Mater€ol ............If yes,type ............... ............ <br /> (Plot plan, showing size of lot, locations of system in relation to wells; buildings, etc. must be placed an reverse side. <br /> NEIN INSTALLATION: INo;septic tank or seepage pit ,permitted if public sewer is available within 200 feet,) -s <br /> PACKAGE TREATMENT [ ] I� SEPTIC TANK f Size------.......................................... Liquid Depth <br /> Capacity .................... Type .................... Material....................... No. Compartments ..:....... ............ <br /> Distance. to nearest:'Well . .Foundation Prop. Line <br /> i <br /> LEACHING LINE [ l No.- of Lines ------ •------_ Length of each line............................ Total Length ................ � <br /> 'D' Bax ....... .... Type filter Material ....................Depth .Filter Material <br /> .._-__ Foundation ..:..._..Property tine <br /> Distance to nearest; Well ------------ ........... -.........-:• ,- ---•----••..............� <br /> SEEPAGE PIT [ J Depth -------------------- Diameter Number _.............. ............ Rock Filled Yes Q :No 0 <br /> Water Table Depth -........................-----..................Rock Size <br /> Distance to nearest: Well ..Foundations _ Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date . <br /> Septic Tank (Specify Requirements). T'_.__.... <br /> ............... ...-•-•-•---••.............. <br /> Disposal Field (Specify Requirements) -_- • ---�� - ................... .......... <br /> ------ ------- --------- <br /> — � f ......_.. <br /> ............. _....... '�i ................................................. ............... .. <br /> ii {Draw existing and required addition on reverse side! <br /> 1 hereby certify that I have'prepared this application and that the work will be done in accordance with San .Joaquin f <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, l shall not employ any person In such manner ' <br /> as to become subject to Workman's Compensation .laws of California." <br /> Signed -------------------ie" <br /> •---------- ll- - -------- -- --. ------------•----•••••-_.. Owner <br /> I€ ofr t o�--BY --.... -•------- --•------ Title ...... . - '( wren) <br /> FOR DEPARTMENT USE ONLY <br /> - -- . <br /> APPLICATION ACCEPTED BY --' ---- -- .......................... ---- ----,, DATE . _ ........... <br /> BUILDING PERMIT 15S11ED !�.......... =••---'---•-•----------•-----•-•-• ........... ............. ------ ----------------'--'----.... <br /> ADDITIONAL COMMENTS ... ..............: <br /> ----------------------------------------------!`.. <br /> .........................----------.' ...- .._.....h................................._..-...._................................__...._.............._._.........`..... <br /> --------------------•--•------F..._ -i ._••__•_•___._...._.... <br /> e <br /> find! Inspection by. _ � •...................................................Dot . ......, .......... ...... <br /> EH 13 2h .`68 Rev. 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7li 3M <br /> ,� 1 <br />