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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> 7..L.=�-� ��• <br /> (Complete to Triplicate) Permit No. <br /> ----- - ------------- "- --- <br /> .__-__--_.. ThisPermitExpires] Yearfrem Date Issued Date Issued . .........:.... <br /> Application is hp-relay made tothe San J aquin. Local-Health.District.for a permit.-to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance Nc. 549 and existing RulesandRegulations: <br /> JOB ADDRESS/LOCATION ... 5...�=..._ t�? t^�^ __ _.____ewf_d....... 1�eQ_CENSUS TRACT _...'..`!�. ............ <br /> S <br /> Owner's Name .-----... .. . - --------------------......................................................... .. one .----------........---........... <br /> Address - n Ph - - .._........ <br /> -- --._.o?:.. .. ........:yl.:---.r,�4 /�-a�*�:•-�.- 1.��_.._-`- --. City ... — ----__. <br /> Contractor's Name r. .-- . "� ate' License # .�88, .Y Phone ---------- - <br /> '^ j <br /> Installation will serve: 'Residence ❑ Apartment House❑ Commercial Trailer Court 0 j <br /> v-�lMotel E] _ _ <br /> Other _ - <br /> Number of living units:._. ._.. Number. of.bedrooms _t7—___Gorboge Grinder ....------.. Lot Size ------- 1 e�... <br /> Water Supply: Public System and name ...........................................--......... -------------------- --...... ....................Private <br /> Character of soil to o deptf!of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam 0 � <br /> Hardpan Y Adobe 0 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;tahk or seepage pit permitted ublic sewer is available within 200 feet,) r \ <br /> PACKAGE TREATMENT [ I SEPTIC TANK Size . ... ... ... .5.......... Liquid Depth ------- -------------------- <br /> Capacity 1.: Po. TYPe�,�.^.rk�: ___= Material__ 4: __ No. Compartments ..'e.�........._... <br /> Distance to nearest: Well .._... �_�.................Foundation ...1..o..�....._.. Prop. Line <br /> 1 / Y I ttt <br /> LEACHING LINE [�No. of Lines ......__l......_....... Length of each line..___._ -- ..... Total Length ..f.9_Q.............. <br /> V Box .t- Type Filter Material .4�t.. .........Depth Filter Material _./. ......--------------------........ <br /> Distance to nearest: Well ..._ �...+.�......... Foundation __ .... �.-�.__... Property Line _.S~.�______..... <br /> SEEPAGE PIT [� Depth ..._ �___- Diameter _ J.3.F._ Number ....__ _r,.._._„_ Rock Filled Yes No ❑ <br /> Water Table Depth -.-----__21b”! -- .--..Rock Size --��.?---. -- ----._ c <br /> i <br /> Distance to!.nearest: Well _.____fib ---------------.-Foundation ---f_-,b......... Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation I Permit# ............. Date ......................... <br /> Septic Tank (Specify Requirements) -------------------_-----..........::...................-....................... ------.... ......................... <br /> 1 <br /> Disposal Field (Specify Requirements) ................................-''--------......................................................-.................................... <br /> ------------------_.-._ .............._._. ---------- ....----- --- ­­w---------- - ---------------- <br /> t <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 /> "1 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 ._ I (� . Owner c-- <br /> ---...................................---- - ----- bb..__ <br /> By ----------'-------------------------------'v---- --------- . .. ....-."e"-------------- Title ----Ct°6_/K__-__ .. "_`_ �._......---------------------- <br /> (if other than owner)i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY, ---------------------- DATE .. -.Z..----------.--.... <br /> BUILDING PERMIT ISSUED ---- DATE ..................... <br /> ADDITIONAL COMMENTS - - ---------- ----- -------•------*.------.. <br /> - - - /![ ..............-- ... ------......I--------_------ ----- .- ......._....._..--------- ------------------ -- - <br /> - - ......--........ <br /> - - - - <br /> -------- - -- --- -----_--- ..................... -.............. - ---- - ---- ....__....................................__ <br /> - Final Inspection by: ...... .. . `-----------------------------.------------------------------------Date ._----•--�,-........... --------------.. <br /> l SAN JOAQUIN LOCAL HEALTH DISTRICT <br />