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3 <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> rt. 3 <br /> Permit No. �..:...Q=. <br /> ICamplete In Triplicate) <br /> ........ <br /> r--•--•...................•....-......•. <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 complia ce with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB 4DRESS/L TI!N .__.._ -_- -/ �. ._ �Cl�Xao <br /> CENSUSTRACT .. ..... <br /> Owner's Name .. I <br /> r.. t.._._.. .. Orle .....- ................•. <br /> t� v� <br /> Address __.. <br /> ---__ --- -------------...................... City ........ .....--...... <br /> Contractor's Name .... -----•---------------• --•-....-----•.. License # .._..._.. Phone <br /> Installation will serve: Residence$Apartment House❑ Commercial❑Trailer Court, C] <br /> Motel-Q Other.....--------------------------------*........ <br /> ------=------ ---------*......._ <br /> Number of living units __ Number of bedrooms _..___.Garbage Grinder ............ Lot Size}3y <br /> Water Supply: Public System and name .....................................••---•---...•-•-----_.....-...._._........---........ ......Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt Ij Clay ❑ Peat❑ Sandy loom 0 Clay Loam ❑ ✓� <br /> Hardpan 0( Adobe 0 Fill Material ........_...If yes,type............... I........... �. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) . <br /> NEW INSTALLATION- (No septic tank or seepage pit permitted If public <br /> —Vsewer is available within 200 feet,) 1 1 <br /> PACKAGE TREATMENT [ 3 SEPTIC TANK Size-- X �_------- _--- Liquid Depth -- ---�'�.__..._-- �J <br /> Capacity -11.0-0-_-... Typef p4 Material.21 o. Compartments ....�.�jj......##►►� <br /> Distance to nearest: Well -1�7f�-- ------------------Foundation ..._�.� t.... Prop. Line ......4��i..._. <br /> LEACHING_LINE No.' of Lines _._ ------------- Length of e In ........ Total length ----/_2..f.� <br /> ...... <br /> . <br /> �� <br /> '©' Box . ._... Type filter Materta'1 ---.... ----D" Depth .Filter Material .....L. ---.--•-•-------------------- <br /> d! .... Foundation __/0K <br /> r <br /> f3istance to nearest: Well --- --------•-•----- ..........Number ..... Property LineT.. <br /> SEEPAGE PIT Depth _--- ��.-. ...-. <br /> _ <br /> r� ,r ---------------- Rack Filled Ye No (3 <br /> [,� __<.-.�----- .Diameter .11"­ �_ _ <br /> !' <br /> Depth Water Table De <br /> p ------------------------•--.....................Rock Size -------2.::-. ......-•------- <br /> Distance to nearest: Well ---- . -/----------------Foundation ..-- �._...... Prop. Line ....Q <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------_--....__.------ Date ...................................I <br /> Septic Tank (Specify Requirements).------------------- ---------------------------------------•-- •_..... ---....................................................... <br /> Disposal Field (Specify Requirements) ---•- -----.----_----------_---- --------••- •--------------- ........................... ...... ......... 1 <br /> ------------------------------ <br /> T _ <br /> ------------------------------------------- .... <br /> ------------•----. _ <br /> (Draw existing and required addition on reverse side) 1 <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 licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is.' issued,:f-shall not employ any person in such manner <br /> as to b e ub ect o Workman's Com ., - ° i I., "" ! <br /> 1 W on laws of California: <br /> Signed :..._-ill.... ......---.......... Owner <br /> By ----------- ' Sitio __ <br /> --- -------• ----;-------------------•------------------- ------.......................... ------ ._.......... <br /> (!f other than owner <br /> FO EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _-- ------ DATE <br /> BUILDING PERMIT ISSUED •.. •---..... ------------------DATE ...._.:..--•----------------- ------------- <br /> ADDITIONALCOMMENTS ........... 4....................... -------- --- --.............• -----------....--------------.....---.. --------------- --- <br /> ------------------------------------------- _------------....-—.........�....... _ _..._..._...._.....•--.......... ............................................................... <br /> ----------•-------- <br /> Final Inspection by: ..__L:_. --•..............•--...._.I----------------- .......-Date /? ------•-- <br /> 13 24 1-68 Rev. 5h4 .SAN JOAOUIN LOCAs. HEALTH DISTRICT 8/7a 3M <br />