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FOR OFFICE USE. ,,-APPLICATION FOR SANITATION PF._,4T <br /> . .. ....... ....... . . ........". Parrmit No. <br /> (Complete in Triplicate) <br /> .............................. <br /> Oat* Issued <br /> .............................. .....I...... This Permit Expires I Year From Oat*Issued <br /> Application is hereby made to the Son Joaquin Local Health District for 0 permit to construct and Install the work herein <br /> described. This application is made in compliance with County Ordinance No. SA9 and existing Rules and Regulations, <br /> I ADDRESS/LOCATION ' t; ,/0, __ . .- . CENSUS TRACT .... ........ <br /> 08 ADDRESS/LOCA . ......... . <br /> Owners Name .... ...........I.,........... -_Phone <br /> Address City .. ... .......... <br /> :ontroctor' .. .. .. .. .. ....... <br /> Phone <br /> s Nam* ............... ...............License <br /> installation will swvet Residence Apartment House{] Commercial (nTraller Court C] <br /> Mote( (7 Other . ......................................... <br /> Number of living units:...-(...... Number of bedrooms -.Garbage Grinder ............ Lot Size ZY .. ..................... <br /> Water Supply-. Pvblic System and name ...........................................................................................................Private <br /> Character of sail to a depth of 3 feet, Sand n Silt[D Cloy 0 Peat(:] Sandy LOGM 0 Clay LOGAN)q <br /> Hardpan Adobe X Fill Molorlal ............ If yes, typo ............... ............ <br /> (Plot pion, showing size of lot, location of system in relation to wells, buildings. etc, must be placed on reverse side.) <br /> NEW INSTALLATION- (No septic tonic or seepage pit permitted if public sewer is available within 200 fest,) <br /> PACKAGE TREATMENT ( I SEPTIC TANK I I Size-...-----__................................... Liquid Depth ... .................. <br /> Capacity ............ ------- Type ..............._... Material...................... No. Compartments ........I._.........._ <br /> Distance to nearest: Well ..........................._-Foundation .__._.....I..____..... Prop. Line ................. <br /> LEACHING LINE I No. of Lines ........................ Length of each line.....................---•_ Total Length -------_---------------- <br /> 'D' Box ............ Type Filter Material ...............__Depth Filter Material ....................................... <br /> Distance to neamtr Well - Foundation ........................ Prop" Line ......................... <br /> SEEPAGE PIT Depth ........... Diameter ................ Number ............................ Rock Filled Yes ❑ No CD: <br /> Water Table Depth ---------- --...............Rock Six* --_------------------ <br /> Distance to nearest- Wolf -------------- ........................Foundation -------------------- Prow Line .........------------- <br /> REPAIR/ADDMON(Prev, Sanitation Permit# .......................... ................. Date ................. <br /> Septic Tank (Specify Requirements) --------------- ....... ...... . ..... __........__._.r....................._........--•.._.........._.--_.. <br /> C)Isposaj !reed (Specify Requirements) <br /> ocz__ ' ------------------.••-----------------------•.---•- <br /> ............................................................................................................................................. ................................................ <br /> ............-................. ........ --------....................................................................................... ..... ..... .......... .... .................... <br /> (Draw existing and reqvimd addition on reverse side) . ... . .... .. <br /> I hereby cwtft that I have Pr"PGF*d this QPPJlc=tkM oad that the work will be dere In 111111 GO" with Son J10"Wil" <br /> County Ordinances, State Law,, god Rules WW ft&gwiadons of the San Joaquin Local Health District, memo owner 4W Ikew <br /> sed agents signature certifies the following- it is issued, I thad not employ OnY Pets" I#' such man"'or <br /> "I certify that in the performance of the work for which this Pam <br /> ,is to become subject to Workman's Compensation laws 0# CaMomio." <br /> Signed ............................................ <br /> Owner... ............ ....... .................. <br /> By <br /> ..................... . <br /> Title .. ............... .. . .... ..... . <br /> (if othe on owner) <br /> FOR DEPARTMENT USE ONLY <br /> ------------ <br /> APPLICATION ACCEPTED BY ...... ...................-------------- DATE <br /> i .....DATE , .......................... <br /> 8UILDING PERMIT ISSUED ........................11---------I........ .r•----.......-_.: -­V_­-­ <br /> ................. <br /> AC-OiTIONAL COMMENTS .. . ........­.. ..'­.................................................. ....... I... .......I............... .. .... .................. <br /> .......... ......... ..__........................ .....­1....... ....... . I.......... . <br /> .............. ........ ......... ... .... ..... .......................... .. . <br /> ...;..'........... .. ...... .................... . <br /> ........................*­­­....... .. ................ ....... ............. <br /> ................ Date .... <br /> Final Inspection by: .........................................----------------------- - ------*------- <br /> 3 24 1­6,1 ?cv. 514 SAN -'OAQUtN LOCAL HEALTH CffSTRICT <br /> 8/7h 3M <br /> C. <br />