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FOR OFFICEUSE: .3 �,, `' <br /> APPLICATION FOR SANITATION PERMIT ,�,['_// 7d-/v3 n <br /> =........ . --------- ------ (Complete in Triplicate) $C1 w;;O l Y6 Permit No. .................. <br /> ' <br /> .................... <br /> "73g . Date Issued .�°'./.°I.'...�v <br /> ------ *_-This..Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .---:/-.-- t.w-..... Y. ....CENSUS TRACT ------ ----------•-•---•• <br /> Owner's Name .. Phone _......... <br /> A= ---- ...................... <br /> .............- - <br /> �f• <br /> �................. City � ��- --- <br /> Address . /u�.a�p�....-�------------- - --- --•-------------•--._...., /�. �c�// �- <br /> ,�} License# -7 Phone * - <br /> Contractor's Name _ ­.- .41...4- . .2,r�.< .. ... ...........•---•--.:__ .. - ' <br /> Installation will serve: Residence ❑ Apartment House❑ Commmm cullet Court 'C] <br /> Motel ❑ Other <br /> Number of living units:..........-- Number of bedrooms -----Garbage Grinder ...... Lot Size -------------------------------------------- <br /> Water Supply: Public System and name ............. .................••--- ------------- -------------•...........................................Private <br /> Character of soil to a depth of 3 feet: Sand'[$ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ,M <br /> Hardpan ❑ Adobe ❑ Fill Material .........__. If yes,type ................_---------- <br /> IPI'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) \n <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT I I SEPTIC TANK T ] Size_�.__j._._t... - Liquid Depth _411__- <br /> Capacity /W------- Type _. Material_ o. Compartments _.2................ <br /> Distance to nearest: Well -------------------Foundation --/!0------ <br /> ._.._ Prop. Line <br /> LEACHING LINE [ ] No. of Lines ... Length of each line.__ - ------------ Total Length .4�6Q-.............. <br /> 'D' Box ...------... Type Filter Material _ r5�-----Depth Filter Material - ---------- ---------------------. <br /> i Distance to nearest: Well ._-.-�.4----------- Foundation ------ --- ..--____ Property Line - -------------------- <br /> SEEPAGE PIT ( ] Depth ----- Diameter ................ Number ............-............... Rock Filled Yes .0 No i❑ <br /> WaterTable Depth ....-------------_-..--------------------------Rock Size _--_--------------------_ - <br /> Distance to nearest: Well ----------------------------------------Foundation .-.........--------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ________________-.-.. ------------------------------------- Date -•---••-•-------............---•-• <br /> i <br /> Septic Tank (Specify Requirements) •-------------•- ------_-- -•---•-------•-• ..............,............................. <br /> DisposalField (Specify Requirements) .------------ ------------•----- -----...-----------------------------------------------............................... ----------- <br /> f ----------------------------------------------------------- - --------------------------------•---------- ...... <br /> ---------- - ...... - ........................... ................._..----------------------.. -------------- ........................ ..................... ................... <br /> ;Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> i 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, 1 shall not employ any person In such marine# <br /> as to become subject to Workm n's Compensation laws of California." <br /> Signed ........ ... --•-•...................r. . .............................. Owner <br /> By ---------------------------- Title .... --- -- -- -- ---------. -- ....................... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> Y <br /> .......................................... DATE .... .. . . <br /> APPLICATION ACCEPTED B <br /> BUILDINGPERMIT ISSUED ..--...---•---•..................... . ............•-•-------------- -.......------.............. .....DATE ......- ------------•--------------.--.-... <br /> ADDITIONALCOMMENTS ....... -------- ......... ... ............................._.......... .. -- ------ ._.............-----....•- ............................................ <br /> ............. ------------------------ - ........................ ----------------....-•---... .................................... .......................... ------------ ---... <br /> .. .. ......... -- --------- ------ -- ----- .._..................- ......••----.......................................-- ------------•--- --- -...... <br /> _... ............... --- --- - - --• - _......... . � -- <br /> Final Inspection by: ----------••.............Date .._............... - _ <br /> t► SAN AQUIN LOCAL HEALTH DISTRICT <br /> l <br /> E. H. 9 1-'68 Rev. 5M <br />