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APPLICATION FOR SANITATION PEPMiT <br /> (CliPermit No. <br /> ........................................................ ................... <br /> ......................................................... This Permit Expires 1 Year From Date Issued <br /> Date <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 in compliance with County Ordinance Not 5.49 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION. ...r.L�0/. 6..}.. �� <br /> •- <br /> .. ._ . . � -.. ...., . <br /> .: ).CENSUS T <br /> RACT .....................• <br /> •-•. <br /> Owner's Name _.. f � �--- S ... . ' ..- <br /> hone . <br /> Address � .......................................' _ City c <br /> Contractor's Name ........... ...... ...... ...............License t1E. .Y:S.y Phone <br /> Installation will serve: Residence ❑Apartment Ho;4. <br /> sefl Commercial ❑Trailer Court 0 <br /> Motel p Other/C�, ._. kee -t: .. <br /> Number of living units:_._----._.. Number of bedrooms ............Garbage Gri er __-_ Lo ............................................ <br /> ..._. Lot Size ize <br /> Water Supply: Public System and name ,---•--------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe 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 tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT j ] SEPTIC TANK Size. ........................ Liquid Depth <br /> .-.... _ <br /> Capacity /, 'C1� _ Type Material. No. Compartments ..._ .......... O <br /> Distance to nearest: Well ....................................Foundation _...10.. ........ Prop. Line ._-S.. .......... O <br /> LEACHING LINE No. of Lines ---------- Length of�ach line.-_._. .Q..'..._._. Total Length I ........._._. <br /> 'D' Box ...... _.. Type Filter Materia( ..Kt ........Depth Filter Material ........f2._1,11......................... <br /> Distance to nearest: Well ........................ Foundation _...1_ ._.......... Property Line 4....�............. <br /> ol <br /> SEEPAGE 1?JT Depth- <br /> ----- Diameter .. ..._. 'Number .--- ed Y <br /> Rock Size �/v..x__�;L <br /> Af 00 <br /> Water Table Depth ................................................ - -•----F!--- � 1 <br /> Distance to nearest: Well ........................................Foundation .._...�P..f.... Prop. Line ...:�.............. <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ____________________________________________ Date .................................. <br /> Septic Tank (Specify Requirements) ...-•--•---•........................................................... ...----- <br /> ---------- <br /> ......... - --........_... <br /> Disposal Field (Specify Requirements) .-•-••-----•--•.............................•----•--•--..._..............._..---•--•--••-•--•---•-------------•---....._............. .. <br /> .............................................. -•----------------•-----•.....-----••---..__........---•-•-•-----•-..................-•---•••-----•--...•-------•-•--......_•-----•---......... <br /> ------------•-------••----------•------•--•-••--•----......--•-•-•------•-----••-------•........................•....................--- <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 Work an's Compensation laws of California." <br /> Signed _ -- . --- • • -•-------•-- {} Owner <br /> g -'� N.._... y <br /> Y • .-- -- .......... ...t-------------------------------------------------------- Title .... <br /> (If other tha wner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- -- -- . ---- •-•-•--•-•---------•---••-...-----•---...•••--•......-•----•-••----_.. DATE --. .......d'...71z_....•-•--••-:. <br /> BUILDING PERMIT ISSUED D E: <br /> ADDITIONAL COMMENTS ._16" V .. -rc- �.�.��. ........_Y'P2_--. ............................... <br /> r e.� <br /> -----------I.-------•-••---•--•------•-•---------•-•-••---•--•-----•..............................•--••---...----........_.._..-_..............-•-•----.....-----••_............_. <br /> ._.. ---­--------- ----------- --- ----------•-------- •-................................................................................. <br /> ........•--... <br /> ....................... <br /> .................... <br /> EH <br /> ------ -- ------------------------ -- .. . -••--••--------------..........................-• --.......•......._....._..--•--..._._....... <br /> FinalInspection by: ...... - --- ------------------•--•....--•-•-......... ------ ................--•---•-•-...._Do. _... 2 G. .._............. <br /> 13 22t 1-68 V. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />