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-,tf-C <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No -1--............. <br /> . <br /> Qdte�1 4Vued 5-:.� 7 L <br /> F - <br /> ._____-_-_-.._____...._.-__� - ..-,.-_...- This Permit Expires 1 Year From Date Issued �..�. <br /> r <br /> Application is hereby mt0,: i 4atJ&quin Local Health District for a permit to construct and install the work herein <br /> described. This applicgto isgc i compliance with County Ordinanc No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCAT� _... < .._.. - = - ; i' P� - - - -CENSUS T -------------------------- <br /> ------ <br /> ---------------- ----- <br /> TRACT <br /> Owner's Name - ----..L-l- ,-- -- -'_...._.__..-- --`-'�'.Gt L.P::?��'f+'L--- -------------- -- ----Phone V."".oT ------- <br /> Address _ . �- !Y-. q�-..' - --------- City . - <br /> Contractor's Name --_ 3-.. .. -_- ._ _-....: ---_----------.License # / Z):__S_1/----. Phone <br /> Installation will serve: Residence [[Apartment House❑ Commercial ❑Trailer Court ,❑ <br /> Motel ❑Other ..... --------------------------------- ---- <br /> Number of living units:.-.-. ----- Number of bedrooms --3-----Garbage Grinder .______ Lot Size ..._.---.f--a -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 ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material .... If yes, type------ --------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ 7 SEPTIC TANK[ 7 Size------------- ........... .................. --- Liquid Depth ____--__------.-_-- -n <br /> Capacity ------------- -- Type ----------__...... Material--------------------. No. Compartments ---------------------- IN <br /> Distance to nearest: Well ----- ---------------------Foundation -------- ----- Prop. Line --------------------. T <br /> LEACHING LINE [ 7 No. of Lines .. -- ..-__-- - Length of each line--------------------- ----_ Total Length ------- ...... _ ---.----- V <br /> 'D' Box ..-_..__- Type Filter Material --.----_---_-----Depth Filter Material ............__.......__................. <br /> Distance to nearest: Well ------------------------ Foundation ---------------------.-- Property Line ........................ 6\ <br /> SEEPAGE PIT [ ] Depth ---- _-_-------_. Diameter ---------------- Number .-_.__... ----------------- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth -----------------------------------------Rock Size ----- -------------..---- <br /> Distance to nearest: Well --------____--.-..- -------_-......Foundation ____----........ Prop. Line ------_-------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -----___----___-_-----_ ------ ---- . Date .--------------------------------- <br /> Septic <br /> -..----____------------- --Septic Tank (Specify Requirements) ..... ----------_.........--}.... _. ----- ---_ <br /> Disposal Field (Specify Requirements) -_--.---a,-Jd-..-.__-Q.f/--- -. 't .----. ------- _:_-_.--... _- _-�___--_--- <br /> n �r <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, 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 manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed _ ... . - ------ -- ---- ------- „ Owner <br /> By --_......- -. ..._.- . - _ Title . r <br /> (I oth an owner) <br /> ZF�R DEPARTMENT USE ONLY <br /> : <br /> APPLICATION ACCEPTED �� <: 4 -...y_-..._ <br /> . . - ................... DATE <br /> BUILDING PERMIT ISSUE <br /> - - .......... __ - -r----------------- -- - - DATE <br /> ADDITIONAL COMMENTS _.__--- -- --- ---------------- ----------------------------------- _ <br /> _.. ------------ -------------- ---- -- -- ---- - ---------- -- ---------- - --- -- --------------------------- ----------- ------ --- - -- - ------.......... <br /> - - -- --- <br /> --- --------------- - - -- <br /> Final Inspection by: - I - ( :�� i '��.� - . -Date . `t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />