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f <br /> FOR OFFICE USE: <br /> APPLICATION FOR1 SANITATION PERMIT <br /> -------------------- t Permit No. .r ' �7 <br /> f (Complete in Triplicate) 'may <br /> t - - ---------- ------------------------------------------- . Date Issued <br /> fr This Permit Expires i Year From Date Issued' <br /> . .......................................... ........ - <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 lira.compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION , _ _ ..._ r-- _ -=- •--- -- -/---......^^ •.- CEi�SUS TRACT <br /> �� <br /> Owner's Name .-. ... -�1J.L'ti-�--»?----- - .. _....-----•. ............... . . ----._..._Phon _..-- --------••-------._... <br /> '+ ---------- � Ci <br /> t<_ ....................................... <br /> Address ---._•'�a2�_.._ <br /> / f _4 ✓A0 ' -------- <br /> Contractor's Name License # .3 '••--•- Phone ..._...._.;..__ <br /> Installation will serve: ,Residence Apartment House❑ Commercial :. railer Court �] <br /> Motel ❑ Other ---------- - ----- • ...... <br /> Number of living units:.._ Lumber of bedrooms .._-._.__-..Garbage Grinder .... ------- Lot Size ----------- ------ :-.------- <br /> Water Supply: Public System and name .................. :..--...-:.•..- ....................... <br /> --Privte,; <br /> ---•----- <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay,. +• ...'Peat C3 Sandy Loam t] :- Clay Loam D , <br /> Hardpan ❑ Adobe ❑ Fill Material - If yes,type ..__>.�......:---------.-,- <br /> '{•Plot plan, showing size of lot, location of system in relation to wells, buildings, •etc.'musf.-be placed on -reverse side.) <br /> NEW INSTALLATION: (No septic tank or seep a pit permitted if' ublic se%yer is available within 200 feet,) �* <br /> 'PACKAGE TREATMENT [ ] SEPTIC TANK[ Size ;.x: '- -_' •( _ Liquid Depth ----.--- <br /> 1 0 �� ¢ Material Nom Compartments r. :--• <br /> r <br /> 4 Capacity . _-.... YPe �'.' `t <br /> j <br /> �oo <br /> to neares : Well ............ Q_ Foundation ..., :�.4_...-.---.- Prop. Line ...:5_..-.--..--- <br /> J 'S O <br /> LEACHING LINE'% [ nes ...... •. • - Length of each' line:...:. S ...... Total Length ___....`i......:........... <br /> -� , <br /> Box.. tarest: <br /> Type Filter Material .. -.�(�:..__.Depth Filter Material .....I. .__�-------------- -------•---•- <br /> r ,/ <br /> S t1`. <br /> Distance'' Well ___.--V.D_0......... Foundati6n ...�_ :.............. Property Line i...-. <br /> �� Rock Filled Yes No C <br /> "SEEPAGE PIT. [ Depth _J�.......... Diameter �. .�., Luer ------------ .. <br /> Water Table Depth ....... ...... 1.a....---'--.. .............Rock Size --- ... .............y----- 4 <br /> - ' <br /> t 0 r 0 ' Pro Line ... '_..... <br /> `f <br /> Distance. nearest:.Well�_`...._:�.5 -.._..••.•---• Foundation,....•........_.•..-. p <br /> /,ADDITION{Pre'v. Sa <br /> .__n..i "�_.!.. <br /> .,,r:REPAIR' tation Permit# ••..•..••--•••••----••••••---------••---••f- Date ----------­­. <br /> 'Septic Tank (Specify Requirements) ----------------------------•-- i. . -: <br /> Disposal Field (Specify Requirements) .. .......................... I......---,.... _ ......... ......................_.................\............... <br /> f .......... .. .. .... <br /> �= .......----•------------------------------ <br /> 1 -------------- <br /> _ ..... 5 ---- r!-.. <br /> ; (Draw existing and required addition on reverse si e) <br /> 1 i herebycertify that I have prJoIred this application.and that the work will be done in accordance with San Joaquh <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local_ Health District. Home owner or licen <br /> sed agents signature ce ifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ anyperson in such manna <br /> as to become subject to Workman's Com ensation'laws of California." <br /> Signed ------ -•----.....� --- - ------ <br /> ---- ------------- Owner <br /> B ,_........_._ <br /> 1 �• ----.----•- Title ...._. ................. <br /> ! <br /> ! (If other than owner} <br /> FOR DEPARTMENT--USE ONLY <br /> APP LICATION�ACCEPTED- BY __..._-•- -_..._... .... DATES ."�'�-''lt. -.---...--•- <br /> BUILDING PERMIT'ISSUED .----------•------- --•- ..-----•---°..............DATE -.....-•-----•-.-------.----.------------ <br /> ADDITIONALCOMMENTS:------ ...............•-.....................................................-.........................................----- = <br /> t .. ------------------Y---------------..... <br /> --�_ <br /> : : ......-- .......... ( <br /> s Final Inspection by: . ............. ............... .. <br /> Date <br /> i SAN JOAQUIN LOCAL HEALTH DISTRICT <br />