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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ..._..•--._..................__...................... <br /> (Complete in Triplicate) <br /> ................................. <br /> Date Issued .��: -_...-_-.. <br /> - This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is mode in compliance with County Ordinonc No. 549 and existing Rules_and Regulations: ! <br /> . y _ <br /> ��� '-- "•• `? ,$ TRA <br /> JOB ADDRESS/LOCATION .. .......-._� _•-- -_--- -- n .__.E?t -t8t7 S <br /> Owner's Name ..-..._: :y.. _-.Phone -•••--:»....»»...:»......_..-••- <br /> ._. .. <br /> .... ........................... <br /> Address - -7....-. • ------- ._ .. <br /> ,. _ �/- .......:.License # >%.. .. �ar►ef._».�»_........- _».. <br /> Contractor's Name ..... <br /> •' <br /> Installation will serve: Residence Apartment House❑ Commercio Trailer Court 0 c i ' <br /> Motel ❑Other.. 72t-." ... ---=•- - <br /> Number of living units:----/ . Number of bedrooms . .Garbage Grinder..............Lot Size ....................................... • <br /> -................................................. ............................... .-Private <br /> Water Supply: PublieSystem and name _•_._.._.... .-._ - <br /> Character of soil to-a depth of 3 feet: Sand 0 Silt❑ Cloy [3 " Peat❑ Sandy Loam lay Loam ❑ <br /> Hardpan 0 Adobe ❑ Fill Material .............If yes,type____________________________ <br /> (Plot plan, showing size of lot, location of system in relotion to wells, buildings, etc. must.be placed on reverse side. i <br /> NEW INSTALLATION: (No septic tank, or seepage pit permitted if p blit sewer is available within 200 feet,) <br /> l / s ! <br /> 4 ' <br /> PACKAGE TREATMENT ( 3 SEPTIC YANK; Size...� .. .-1�----- ------•: - ......"Liquid Depth f�'L.................. <br /> Capacity IcQ.d..... TYPO. Material.-__ No." Compartments ":........: <br /> / 4 , I <br /> istance to nearest- Well ............ fl._..._ Foundation ...._/-_42_____-._... Prop. Line ... <br /> ..... ...-------- sem......... <br /> Y�_----- <br /> Length of each line......Z�� ----- Total- Length .:...........`�. <br /> EACHING LINE ['�No. of lines 9 <br /> D' Box - �.----- Type Filter Mote <br /> f.:..:... .........Depth Filter Materi --..... .... <br /> S <br /> Material 1._ ..-. ..... <br /> I <br /> Distance to nearest-.,Well .:.:-. p- .... Foundation :...1..9..........:. Property Line ' <br /> SEEPAGE PIT ( j Depth .................... Diameter ................ Number- ._._-___---_---. ..»...-Rock Filled Yes ❑ " No Qi f <br /> ))tater Table Dept ---- - .............Rock Size -----•----•- .-. ......... _ i <br /> Distance to•nearest: Well _•. ...............................Foundation ............. Prop. Li_rM ----•- -� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# :__.....- .-->:.--:•---••-----__-.__.. <br /> Septic Tank (Specify Requirements) ........ ......„...... �....... »; ....»...»__-.».»._......._ --.._... »....._.:.._......--•---- <br /> Disposal Field (Specify Requirements) ...................:........... .:......................----._....»..---._..».»........._--._.........»_.__..»_.------- <br /> _ <br /> ......................... ..............................................................»..-•••-•--....__.........._......._....----._.......---»»..._»..._..... - ...... <br /> . ..._................».......:__.__-......:—------•-- .-------------------­---•-•' -. — -----•----------_........'♦ ...... _ ._...... - - _....__._.- <br /> .. ,a f <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and ihaf the work will be done in accordance with•Sew JeegttitE <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Neem owaer w- <br /> VdIMA <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 maneter: <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ..--•...........:........ _ Owner <br /> By ........»... _..--.: <'1f-,.4a�� -.._.. 7itle _ . .s............................ <br /> -(if other than owner) 1 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY �.r� -_•---.:»_.._�r..:.__.�»---_--»»:......:........ DATE :-/_Q.." .j...-- <br /> BUILDING PERMIT ISSUED ••---»------ ._ »..... _... ...........»._ - ..». -- ..».:..._;_.DATE........:... .._._...................................... ............ <br /> -•- ................ =- <br /> \DDITIONAL COMMENTS _ °^ ~» <br /> ........................................... .:............:.•...... -----.--•--•----_....___. .................... <br /> •- _ » •- .•..�..................................�`- ......... <br /> Final Inspection lay,._, f Yt�-�r ter.- ........................ ... .. ... ..Data,) .l ._.....__. <br /> SAN JOAQUiN -LOCAL HEALTH DISTRICT <br />