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FOR OFFICE USE: APPLICATION FOR SANITATION PBl�.AT <br /> -- ' ' ---'---•-------'--...----- `. Permit No�3­9`31,4(Complete in Triplicate) <br /> ---------- This Permit Expires 1 Year From Date Issued Date Issued .. ..../7j.._.. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> L <br /> r described. This application is made in compliance with County <br /> �Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION {�f-4----_-- m-----------------_.CENSUS TRACT ....................._... <br /> Owner's Name -.. &r!e„ r! � '�=.", �f --.- .... --"........Phone -' --- - - <br /> .. Address -- -- - - -v` -- ------I--------City ,. i!.........._04§6.....A.............................-- <br /> Contractor's Name ._........ +. ✓_'C ...�.---' '------------------.License #t -IYY.3. 7.. Phone .............................. <br /> Installation will serve: Residence 116 Apartment House 0 Commercial❑Trailer Court 0 <br /> Motel ❑Other ----- ---- I------•---------•----•----•--- <br /> Number of living units: ....... Number of bedrooms ------------Garbage Grinder ------------ Lot Size ...._�� <br /> Water Supply: Public System and name --------------------------------------------- .......... ------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silto Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam)r_ <br /> Hardpan ❑ Adobe 0 Fill Material ._.......... If yes,type ---------------_-- ------ C <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) C <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size----------------------------------------------- Liquid Depth --------............... <br /> Capacity - Type .------------------ Material.................. No. Compartments ........ _. \ <br /> Distance to nearest: Well .----_._..............._._.....-.Foundation.-.-.-.--.-.---.....-. Prop. Line .................... <br /> LEACHING LINE [ j 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 [ J 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 Tank (Specify Requirements) ----------- -'--------- -- _ -------------------------••-•---•-. <br /> fja �lpsal Fie Id (Specify Requirements) --- - _.�-w---- %- ----` - -= - •f�- --•-�+-------- <br /> r - in . / <br /> - -� <br /> -------CA--------..-2-. �- - �P� -- reverse - <br /> (Drawexi ng an requitEd 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 Compensation laws of California." <br /> Signed --------------------------------- -- -- ------------- ----- <br /> - -- ----------- <br /> ' -- Owner <br /> , 1 <br /> By ... - " - - -. Title ' - - <br /> (If other than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY Ft2:�z rr - ----------------------------- " '-"...... DATE ------------------ <br /> BUILDING PERMIT ISSUED --------`-------------'------------- ---- ' - ------ ---DATE ................................... <br /> ADDITIONAL COMMENTS <br /> ---------'---------------------------------°------- . ----'-----------------------'•-•------'---......'------.....---------------._------------------- ................... <br /> _ ----------------- <br /> ---------------------------------------_.....----- ...-.......-----...............------------.......-.-.....-..............................--._...__............--.....--......--................... <br /> ..........................._-------- f__._----- <br /> ;-..._..-..a� .-..---.......-......----•_-.-.---------.-.----- -------------------- <br /> Final <br /> -_....._------ ----------•_-._ T. ..- <br /> Final Inspection by: .. F'r z c` 'r te ;°-----------------_------------------- ............. ---------_--.Date ".✓� . ... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />