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FOR OFFICE USE: PPLICATION FOR SANITATION PERF` <br /> -----------------• --------------•---------- Permit No. ���� <br /> ----------- <br /> (Complete in Triplicate} <br /> Date Issued -/:�&:71 <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 consC-�ti <br /> i §Reygtions: <br /> herein <br /> described. This application is made in compliance with County Ordinance No. 549 and aul <br /> JOB ADDRESS/LOCATI <br /> ' <br /> ------------------------------ TRACT .-------------------- <br /> Owner's Name --------------- ---------- --•-- -------Phone --.-------- <br /> AddressCity -------------------------------------------------------•--•---•-•----------- <br /> Contractor's Name - -----.License #1 f------ Phone7...... <br /> Installation will serve: Residence ❑Apartment House-C].Commercial-.OTrailer Court <br /> Motel ❑Other_---- •*�t.±✓-_ <br /> Number of living units_____________ Number of bedrooms ------------Garb age Grinder.---:-------- lot <br /> Water Supply:Supply: Public System and name ------- ------------------------------•--------------•---------------•-------------------------------------- .Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay 0 Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe V Fill.Material __=,_______ If yes, type ____________________________ <br /> (Plot plan, showing size of lot, location of system `in relation .io- wells, buildings, etc. must be,p!aced[­on- reverse.,side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK t4 Size--------- x_ --_---------------------- Liquid Depth <br /> Capacity/ 1. Type = No. Compartments W <br /> ---- Material___' <br /> Foundation` <br /> Distance to nearest: Well ____ /b-------________.Prop. Line ___ ------------- <br /> --------- 0 <br /> LEACHING LINE No. of Lines -'l ` <br /> :-- length of each Line-----,�Q__------=------ Total Length ---e9•4.-_--------------- <br /> YP Depth Filter-Material ---A? ---- <br /> D' Box __:J�C2 Type Filter Material 1'��4 .�:_.. ____________________•_-_ <br /> Distance to nearest: Well _'__________ ------_____ Foundation. ___ Property Line. ...-5..--___-_-_._._ <br /> SEEPAGE PIT Depth ------- Diameter 3;�_'ro______ Number ------_-1-___ ___-____-__ Rock Filled YesNo ❑ <br /> Water Table Depth ________________________________________ ___ _Rock Size 1'2�r Z� <br /> x <br /> Distance to nearest: Well ---------------------------------------Foundation ----- Prop. Line .---•--------- ...... Q <br /> REPAIR/ADDITION(Prev. <br /> e nPermit # Date <br /> Sep k(Specify Re Requirements) --------------------------••-- ....------ ----------- ----------------------------- <br /> •------------------ <br /> pecify Requirements) ----------------- -Disposal Field IS <br /> ' <br /> i - <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 /> County Ordinances, State Laws, arid 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, i shall not employ any person. in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -----/,� -- - ------------------------- <br /> Owner------ ---- �-- � <br /> BYTitle/ ------------- ---- ----- -----------•------•-------------- <br /> (If er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY __ —------------------ ------------------------•--- ---------------------•--- ----.. DATE ..... <br /> BUILDING PERMIT ISSUED ______________________ <br /> --_--_--------------------•---------------_.---------------------- ---------------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS ------------------------•---------- <br /> -------------------------•------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------- ---------- -----------•---------------------------------------------------------------------------------------------------------- -- ---- ----- --------------------- <br /> ---­------------------------- <br /> Final <br /> -------------------- <br /> ----------------------------- _ <br /> Final Inspection by: ---- -- ----------•- Date ----- <br /> SAN <br /> -- <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> L U 0 1 '40 D.-.. CAA <br />