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FOR OFFICE USE: <br /> PPLICATION FOR SANITATION PENT <br /> __..... ._..._ ..__.... �. Permit No. <br /> (Complete in Triplicate) / <br /> ___-_._._ _ <br /> ......... .... This Permit Expires 1 Year From Date Issued Date Issued .. <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 No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..pS- ��5 ..--.��- ct c. _... _.....__- _ ....CENSUS TRACT ........... .............. <br /> Owner's Name .. .. . . rCtI�FL ems.. -- - .....,...._...............................Phone ...... - ................. - <br /> /�/ - <br /> Address .-.......�_ � . - !(... �� City .....lc «y� v--------................................... <br /> Contractor's Name ....._-. .<Zss.�d..... .... �� ........License # 1 p39.2.. Phone .............................. <br /> Installation will serve: Residence F(Apartment House Commercial ❑Trailer Court 0 <br /> Motel ❑ Other ...._........ - ............. ..... <br /> Number of living units:.......... Number of bedrooms __�f...Garbage Grinder ..... Lot Size ---- ? ..---........._.. <br /> Water Supply: Public System and name ------------------------------------------------------------------------------------------------_........_...Private (� <br /> Character of soil to a depth of 3 feet: Sand L] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan e 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 ( ] SEPTIC TANK[41Size.`J..�(./..P...'!! .S._-..-�. ... Liquid Depth ..........................,J <br /> AV I <br /> Capacity .�.W�. ..... <br /> Type . Material....5° -�.. No. Compartments ._.r`L.-...........rr�__ <br /> Distance to nearest: Well ..........5.f....................Foundation .........L--G...... Prop. Line _.5.........I.......� <br /> LEACHING LINE [� No. of Lines .... ............ Length of each line .-._ F................. Total Length ../!? .. ------------ Vt <br /> 'D' Box ..../...... Type Filter Material Depth Filter Material ----- 5. .:. <br /> i <br /> Distance to nearest: Well ......1r...E'............. Foundation LCL.'............... Property Line �:.—..../_._..........Z <br /> SEEPAGE PIT (vj/ Depth ._-�.rl- . Diameter .eL*..... Number ----------- ...... Rock Filled Yes L- No Q�'/� <br /> Water Table Depth ---...... ,h..-----------------------------Rock Size _. 1 :...t�..d�............ V r <br /> Distance to nearest: Well ---------f04!?. ................Foundation ..../.A.. ........ Prop. Line ........... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............ Date ..................................I <br /> SepticTank (Specify Requirements) -------- ...................................-.------...._............_.....--..--......---...-------..---•----------.......----------M <br /> N <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 /> "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 -- - .............. ......... - - Owner <br /> By .._ .................................................... ................ title ..... -z�.....�.........-........ - ........... . <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . . <br /> . .,;:z:.r.'...'. �:i.4Y..'....._............. .. ........................................ DATE v....... ............ <br /> BUILDING PERMIT ISSUED ---- . ................................................... ........ ..- -------------....DATE ......... <br /> ADDITIONALCOMMENTS ........................................................... ..-----.......------..................------..............................-............-----.. <br /> ..__'.......................................................'--'---'---------'---------...............---................--'-"--------.........----...---"--------------.............- <br /> -.. ........................................... ............................................................. <br /> ._........... .. . -.._ ....... f-.------...-...----------...----.._..----------...-.-........._..............,._.....7.---;-_..yl•....._......----- <br /> Final Inspection by: ... -- --`-= =-----.--'--=--=--:.i-.......................................... <br /> SAN <br /> Date4.....:=------,*`..------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT „tri/ <br />