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FCJk _BICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ---------------------------------------- <br /> ----------------- <br /> _ - � �" <br /> (CompFe _te in Trip icate_. -. - <br /> ------- Date Issued <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 herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules 'and Regulations: <br /> / "W <br /> JOB ADDRESS/LO-CATI : <br /> -----CENSUS TR <br /> ACT -------------- -•--- <br /> -- Phone . <br /> Owner's Name -------- <br /> -- -------- <br /> --------------- - -- <br /> .tiat- _ _ .'�- ----�---- - 1Y1---- -- -- - ^--k. City - ----------- ---- ---- - --- ; - --. _ ...- -- <br /> Addtess,--� ---- -- ._ --- - <br /> -- ` 'e, -�_:_ License #� � <br /> __ Phone <br /> 7�11 <br /> Contractor�s'Name------ - � I F]Installation will serve: Residence Apartmerti Ouse[] Commercial ❑Trai er CtOu <br /> Motel ❑Other - "-- ---------------------------- <br /> d <br /> ---------- - - ' <br /> J � x <br /> Number of living units:__--I ---- Number of bedrooms _6-----Garbage de _-___-I.W* ot•.Size - <br /> -Water Supply: Public System and name ----------------------------------- <br /> _I_Private ❑ <br /> ..Character of sowfbt ,a depth of 3 feet. Sand' Silt❑ Clay ❑ Peat❑ Sandy Loanv� �`CI y Loam ❑ <br /> Hard an ❑ Adobe .r Fill Material______---IIf yes,type# -t� -- -------- <br /> _,,. P-...._. _ t <br /> (Plot plan, showing size of lot, location of system din relation to wells,.,buildings� etc. must be plac�do'h reverse side.) <br /> NEW INSTALLATION- (No septic tank or seepage pi#permitted if pubic sewer is available within 200 feet,} �� <br /> PACKAGE TREATMENT' [•3 SEPTIC TAM1-Type <br /> . Size_ � _ .�I `:�_--- : --,. - LLiqu ti dD!pth .y-----,-----_ _ - -- Matenal__4-tJ �---- No. Compartments Capacity i I <br /> �1A' ----------Foundation __/_._Q----------- Prop. Line---- --------• <br /> Distance to nearest: Well _ _ __-"-__ _ � <br /> Length of ach ine__- .5-------- -------Total Length, :--- - Q•-----•---- <br /> LEACHING LINE No. of Lines __./-.Q� -------- 9 I �, <br /> ✓ ----De Depth Filter Mate�iai. - : - - ------ <br /> ----- --Box ._____--�__. Type Filter Material _ -- ----- P <br /> ---- <br /> Distance o nearest, Well- -------------- - Foundation ----- �- -------- Prope Line ---- --•- ------•- <br /> 0 l 3 `� : �, .---- __-__ Rocky Filled Yes No <br /> th .Roc"' <br /> SEEPAGE PIT Depth -- Diameter Number, _ __-� <br /> Water Table Dep ------ Zee�J.�.. ------- . <br /> Distance tnearestl Well ----------------------------------------Foundation ----- Prop. Line '--- ---------- <br /> REPAIR/ADDITION{Prev. nit tion Permit ---------- ----- ----• <br /> i <br />' ---------------------------- Date -------=---------------•-------- -j <br /> S� <br /> --=-------------------------------------------•.,_ <br /> me <br /> Septic Tank ,Specify Req Ree u cements} - <br /> Disposal Field (Specify q ----- - --- - <br /> ! �"}±�T.._r "� -------------------------------------------------=------------------------ <br /> 1 <br /> F �-----�--- -----------------'Hnreverse <br /> ---------- <br /> (Draw exi ------------------------------------------------------------- <br /> ting and required addition ' sid <br /> ________________"----________- - _ _ e} <br /> I hereby certify that I have prepared this application and that the ork will be done in accordance with San Joaquin <br /> County Ordinances, State;Laws, and Rules and Regulations of the San .toac lin 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 /> iSigned -------------------- ----------------- -- ---- --- Owner <br /> -v ------------------ <br /> By - ----------------(If other t an o" �i/ �. _ <br /> . FOR DE AR7MENT�'�USI ONLY <br /> ------------------------ DATE ------ ---- ------------------------------ <br /> j APPLICATION ACCEPTED Y -- --.`�-t- =-- -- ----- -------- -- ------ - <br /> ---------------------- -- <br /> BUILDING PERMIT ISSUEDv ------------------- --- ---- - -------------- DA ------------- -------------------•--------- <br /> ADDITIONAL COMMENTS .__ '' "- - -------- <br /> ------------ ------------ <br /> ------------------------------- <br /> ---------------------------------------------------------------- -------------------------------------------------- ------------------------------- ----- <br /> ---------------------------- -- --- <br /> -------------------------------------=--- - ---------- -- -- -- <br /> -- --- - ---------------------- ---------------------------------------- ------ <br /> ------------------- <br /> ----- e � -�f.?--- <br /> Final Inspection by- ---------- ---------------------- <br /> -------------- ate ------- ---------- -- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 4 E. H. 9 1-'68 Rev. 5M <br />