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FOR OFFICE USE: <br /> ►lo, 3o *-'APPLICATION FOR SANITATION PIT <br /> ----------- ------ (Complete in Triplicate) Permit No. _V—---5.17 <br /> Date Issued ...vzol2L. <br /> ..,-----------------------------------------------__---- This Permit Expires I 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 Q,11�7. : _ ...... <br /> -.. .. . . <br /> .--.--..CENSUS TRACT ----------..........._... <br /> Owner's Name -- s�� '� �_e ! � ------------ ---- - Phone ----------------------------------- <br /> Address - - - 6Ir1'/ City --- ---- -- -------------------------------- <br /> 0 <br /> Contractor's <br /> -- -- - ----- ---------- <br /> Contractor's Name -__-- :. ' �?/�! ------------------------License #� =,< ��r Phoned' <br /> Installation will serve: Residence t-A-pa'rtment House❑ Commercial ❑Trailer Court ❑ <br /> 9 <br /> Water r I Public t System and name .. - �'---Garbage Grinder/W---- Lot Size ..-l-d5et�Gj�---._.. <br /> ► Number pply in unity.- Numberotof bedrooms � ��� /may Private' E] <br /> Character of soil to a depth of 3 feet: Sand El Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> ` Hardpan ❑ Adobeill 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,) 0 <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'G] Size___------------------------------_---___--- Liquid Depth - � <br /> Capacity -- ----------- -- Type ----------------- -- Material---------------------- No. Compartments .-------------------- <br /> Distance to nearest: Well ---- ---- _------_----------------Foundation ---------------- Prop. Line ---------------------- <br /> LEACHING <br /> _-.LEACHING LINE [ ] No, of Lines ------------------------ Length of each line____--- --------- ------ Total Length ---------------------_...__ <br /> ► 'D' Box _- ---- Type Filter Material _--.--_---.._.._.Depth Filter Material _ ._--------_ <br /> Distance to nearest: Well --------- ___.- ------ Foundation .._______- -___ Property Line ----------------_----- <br /> SEEPAGE PIT [ ] Depth .-_-.-_-,---------- Diameter ---------------- Number ...... ------- Rock Filled Yes ❑ No i❑ <br /> Water Table Depth --------------------------------------- ........Rock Size -. <br /> Distance to nearest: Well _ --- __-----------------------------Foundation ----------_---- ---- Prop. Line ....--_.._-_-_---__- <br /> REPAIR/ADDITION(Prev. Sanitation'Permit# --------__.-__ -_. ,, Date <br /> ----------------- - <br /> a Septic Tank (Specify Requirements) /f� r/.�, _ �i'ly--{.ry y - --� yr-- .�'� <br /> r w <br /> Disposal Field (Specify Requirements) ---------------------------- -------------------------------------------------------- --- <br /> - <br /> - ------ .. .... -------_ _.... - ....... - ...------ -- .. --- - - - - <br /> ----- -- -- -- <br /> (Draw existing <br /> 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, I shall not employ any person in such manner <br /> as to become subject to Workman's Compen tion laws of California." <br /> Signed - - - ------ - Owner <br /> By - ---- -- -- -� ------ Title ..4;t` 'Ysr*-«- <br /> �ot <br /> than owner) <br /> FOR DEPARTMENT USE ONLY <br /> ` APPLICATION ACCEPTED BY -- - -- - - - ---------------------------------------- -------------------- <br /> - DATE ------^ - ------- <br /> -------------- <br /> BUILDING PERMIT ISSUED .-- ---- - ----------------- .....------------------------------------------------DATE - .. ----------- ------------ ---- <br /> ADDITIONAL COMMENTS -------------------------------------------- ------------------ --- ------------- - ------- <br /> -------------------------------------------------- ------------------------------------------ <br /> -----------------------------------------------------c----------------------------------------- -­--------------------- ---------- - --------- ---- --------- <br /> ----- ----- -- - ----by_ --.----- - ; -------------------------------------------------------------------------------------.----------- <br /> ` ~--`- ------ ------------------ <br /> - <br /> Final Inspection -_- - ---- ---------- =- -- -- Date - -----.._-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />