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FOR OFFICE USE: -„ <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. ..................... <br /> ..................... ................................ : <br /> ------------ This Permlt Expires 1 Year from Date Issued Dale issued .. -7� <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 /> -7 <br /> JOB ADDRESS/LOCAT N .f �'d,�...-,n...�, � <br /> . . .. ..... ..........................................CENSUS TRACT <br /> Owner's Na - <br /> ��jj .............................. . ....'--..........phone <br /> Address - <br /> -- _ 4-11----- City __26e,.................. <br /> ........._............. <br /> Contractor's Name ----- <br /> ?� .._ <br /> ... ..:.._.license # ..���..��.�. Phone ---•.......................... <br /> Installation will serve: Res! ence j Apartment House Commercial❑Trailer Court ❑ <br /> Motel <br /> Number of living units:------ <br /> .__- Number of bedrooms ..... c_Garbage`Grinder Lot Size _.. ................. <br /> Water Supply: Public System and name <br /> ----------- ----• ....... ...................I................. . <br /> Character of soil to a depth of 3 feet: Sand)] It❑ Clay (] Peat❑ Sandy loam Clay Loam ❑ <br /> Hardpan Adobe ❑ Fill Mpterlaf ...__..._... if yes,type <br /> y f <br /> a <br /> IPlot plan, showing size of lot, 'location of system In relation torwells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: i <br /> {No septic tank or'seepage pit permittedif Public sewer is available within 200 feet,) � <br /> PACKAGE TREATMENT j ] SEPTIC TANK <br /> __ .�.._ ..��.:......_. Liquid Depth _.. .. <br /> Size .,... <br /> Capacity _JPZ_a--- Typ6 •Material.._.._.. No. Compartments partments ..�. <br /> Distance to nearest.• Well .. <br /> ......Foundation _.....f-c? Prop. Line '° <br /> LEACHING LINE [ No. of lines ....... ---------..__ Length of each fine___..---G.................. Total Length .............. <br /> 'D' Box .....I----- Type Filter Material ....S.-A2.,.....Depth .Filter Material -__- ..`_`-............................. <br /> Distance to nearest: Well:._..j.�G?.Q..�-- Foundation -__------ _�. Pro e Line a <br /> SEEPAGE PIT [ Depth ..._ - iDictrneter ._: .d�. �. Number .........3 <br /> .............. Rock Filled Yes 0�- No ❑ <br /> Water Table Depth ........... - --------------------- �Y <br /> • Rack Size . - -�-•--�.�....------ <br /> Distance to nearest: Well ..._..1-S.d. -_ f2f� <br /> �-----------------Foundation ._�.C7..�... Prop. Line --- --.... .......... <br /> REPAIR/ADDITION lPr4'V:Sanitation Permit# ..........._._.--------- ------------„_- Date ---.._--.--.•..__._._.. ...._) <br /> Septic Tank.(Spec fy Requirements) ---.................--•--•--------------...........------- <br /> ........ <br /> ..... <br /> •...................... <br /> Disposal Field (Specify Requirements) ----------------------------------- - <br /> •___._•--------------•-' -----------------------3- -•-------....---------•--------....._..---------------••---------•------..-._.-------....._.......__...._..................... <br /> - _________ ____ ________________________•._-_---------_------------- <br /> ... .__.. <br /> (Draw existing and.required addition on reverse side) <br /> _ <br /> I hereby certify that l 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. Hence 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 /> Signed ------------•--------------------------•- Owner <br /> BY - .. 2. Title ... .. <br /> (If other than owner) . <br /> t . ......................... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- �_----- - --------------- DATE �..~-.L--/..`..�. ..._.._ --------- <br /> -------- <br /> BUILDING PERMIT ISSUED ----------- - ---------------DATE ....----- <br /> - <br /> ADDITIONAL COMMENTS -------------- •--­----------------- -- ----- -•-- <br /> -----• -••------------•-••----..-----------•---- I..... <br /> I.. <br /> --•---------------- . I..--• - ------------------- <br /> Final Inspection b ------------------- <br /> p y: ..----- -- '----�L*SAN :JOAQUIN <br /> _ . Date , <br /> EH 13 2tt -bfi v. LOCAL HEALTH DISTRICT �'8/7h 3M <br />