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.� <br /> R OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> --------------------------- - ----------------------- Permit No. <br /> (Complete in Triplicate) <br /> This Permit Expires i Year From Date Issued <br /> Date Issued <br /> ___ - ------------------------------- <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 /> JOB ADDRESS/LOCATI N c J-- -----f�--'� G� !/yr - NSUS TRACT -------------------------- <br /> Owner's Name Phone <br /> Address /� � ------------------- City <br /> Contractor's Name �g -- - --------------------------------License #/4!�l.;;W-Phone <br /> Installation will serve: Residence/KApartment House❑ Commercial ❑Trailer Court ;❑ <br /> / Motel ❑ Other ------------------------------------------ <br /> Number of living units:----(__---- Number of bedrooms ,, -_--_Garbage Grinder���- Lot Size r � ---------------- <br /> Water Supply: Public System and name --- ------------------------------------------------------------------------------------------------•--------- -,PrivateX <br /> Character of soil to a depth of 3 feet: * Sand'❑ Silt❑ Clay ❑- Peat ❑ Sandy Loam -❑ 'Clay Loam <br /> — _. T...-- _ ._ . - --- .•� <br /> Hardpan ❑ Adobe ❑ FEIf MateriaE .___. _�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 isavailable within 200 feet,) !,, f� <br /> PACKAGE TREATMENT { ] SEPTIC TANK S;/AM <br /> h-a!-- --------------- -- Liquid Depth ----------------- <br /> Ca <br /> _----.----- -_ W <br /> Capacity _____.__ Type, / aterialNo. Compartments __Z7______________ <br /> -i <br /> Distance to nearest: Well -- --------------------------Fou-ndation _/y----------- Prop. Line --- -- ----------•--- <br /> � Q <br /> LEACHING LINE No. of Lines ____ --------------- Length of each <br /> , "-line -Ile---------- <br /> ---------- --- Total Length le --_._..._....__ <br /> 'D' B;c/e�to <br /> x _j_ 90 --Type Filter Materiall-41664' -Depth Filter Material "�� <br /> - -------------------�---•---- <br /> Dista nearest: Well __901 <br /> ------------ Foundation _/ ------------- Property line _t�7 .----_---___ <br /> SEEPAGE PIT ; Depth _Sr�_ /-- Diameter ��--_-- Number _.___ .-----______.___ Rock Filled Yes No ❑ <br /> tv <br /> Water Table Depth _______ a________________ _Rock Size_____ ---`-•..----- <br /> Distance to nearest: Well __- _ -------------------Foundation _ --- Prop. Line _1 ----------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------.) ` <br /> Septic Tank (Specify Requirements) ---------------- --------------------------- -------------------- ------•----------------- --------------------- <br /> Disposalf=ield (Specify Requirements) ------------------------------------------------------- -------------------------------------------------------------- --------- <br /> ---- ------------------------ ---- :----------------------------------------- - --------- = ------------ ----------------------------------------------------------------------------- <br /> F <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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 lice <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 Compen ` ti. n laws of California." `. <br /> 5igned --------------------------------- Owner , <br /> le <br /> BY ----------------------- ------ - --------- --- ------------------------------ Title ------. �-------------------------------------- <br /> (If of n owner <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION A CEPTED BY _ _ __________ _ _ �]- �rrr 7 <br /> - - - ------------------------------------- -- -- ------------------ DATE --------------�-- - ---------------- <br /> BUILDING PERMIT ISSUED ------------ DATE ------------------------------------- <br /> ------- <br /> ------------------------------------ <br /> ADDITIONAL COMMENTS ------------- ¢` <br /> -------------------------------------------------------- -- -- ---- -------------------------------------------------------------------------------------------------------------- ------- --- ------ <br /> --------------- -------------------------------------------------- ----------------------------------------------------------------- ---- ------- <br /> ------------------------------------ ------ --- - - ---------- --- - - ------- <br /> --- - --------------------------------------------------------------------------------------------------------- ------- <br /> Final Inspection by - --------------------------------- --------Date ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> _ <br /> E. H. 9 1-'68 Rev. 5M <br />