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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ........................................................ <br /> Permit No. ,7 <br /> (Complete in Triplicate} ••"......... <br /> ...........................................:-----•---- , <br /> ................................. .............. This Permit Expires 1 Year From Date Issued <br /> Date Issued :. Id <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 ith County jr <br /> Ordinance N 5 9 o d e,J' ting Rules and Regulations: <br /> JOB ADDRESS/LOC N . m_�_ .�t1t_!`�'�' fl __ <br /> ,�Q . - - - ----- --- -•--�0._.-"�•------- - - -..._..... ENSl1S TRACT <br /> t .. <br /> Owner's Nome J� __ ..................Phone <br /> ! .....�v�*A._^.. <br /> Address - <br /> - <br /> tY -• . -- . .. .._•.... -•--- ----------------- -- <br /> Contractor's Name ----•---•--•- ---- -. -- - -------------.......... ,...License # �------ Phone Or��+-.' �1 .. <br /> Installation will serve: Residence)KApartm t House❑ Commercial❑Trailer Court i❑ <br /> Motel ❑Other -------------------------------.------- .. qa� n,, <br /> Number of living units:-.._/.----- Number of bedrooms.—�_____-Gorbcge Grinder ........_._. Lot Size ..t:.alf-1. V.................. <br /> Water Supply: Public System and name Private{ <br /> Character of soil to a depth of 3 feet:' Sand'❑ Silt❑ Clay ❑ Peat F] Sandy Loam El Clay Loar>�9 <br /> Hardpan ❑ Adobe❑ Fill Material ------------ If yes,type ...... .. <br /> (Plot plan, showing size of lot, location of systemt in relation to wells, buildings, etc. must be placed on reverse side.) C <br /> NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK i j 1 Size ------------------------------------------------ Liquid Depth •_______-___-__.__-._---- <br /> Type Material ........ <br /> Capacity - - - T -'------------------• ..._--•--••-_........ 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 ___.__.._._..__..___..__.-..-._..--_:__.I C <br /> Distance to nearest: Well ........................'FounddfliBn-_'_---___-___________ Property Line _.--_.-_-._______-__---_T <br /> SEEPAGE PIT [ ] Depth .................._ Diameter ___.---------.- Number __- ___....... .. . _.. Rock Filled Yes C] No C] <br /> I <br /> Water Table Depth ' �- ------------------------------•--Rock Size -............................... <br /> Distance to ne elt: Well ---------------_........................Foundation .................... Prop. Line ...................... <br /> t <br /> REPAIR/ADDITION(Prev,Sanitation Per it#-------------................................ Date .._._..... ....................... <br /> Septic Tank (Specify.Requirements) .............. .......... ----------- <br /> Disp sal rF'. d (ape " & Requireme .. . .. - ------- ----------- <br /> I - <br /> --- -. ........................ - ---- -------------- ----------------------------------- --- ------- --------------- . . <br /> &-••� (Draw existing and required addition on reverse side) <br /> 1 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 si nature certifies the foil ing: <br /> "1 certify th t i the performance of th work for which this ermit is issued, 1 shall not employ any person In such manner <br /> as to beco bject to YIVor)(mar's pen tion laws alifornlo." <br /> Signed --- .... ................ ---- --- ---- ---v <br /> By -- --- ----------------------­---- <br /> •----- -- -- -- --- Title ../1 _ . . . . ----- ---- . ------ ------- -- ----- <br /> (If other than owner) <br /> FOR DE ARTMENT E NL <br /> APPLICATION ACCEPTED BY -------------------- �_ 3 ,._... . DATE %a....._....._..... <br /> BUILDING PERMIT ISSUED ........ <br /> . . -•...................DAT ........................................... <br /> ADDITIONALCOMMENTS ................................................ .......---•--.. ---------• ---- ----- ------. ........................................................ <br /> ..- _ . -- ---- -- --...............•-••. ..................-----------------..._---._..._............ . . . . . --•-.....•--•--•-•-•--•-....--••-......__....................... <br /> ------ ----------------- .............................................. ......................................... <br /> . ----------------------------.--.. -- ......... .. - -------- - ....---- <br /> Fin a! Inspection by _._....--- -- - -- --... . .....Date �h t7 <br /> SAN JOAQUIN LOCAL HEAL DISTRICT <br /> C U n 7 ALO n-.. CAA ,� <br />