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FOR OFFICE USE:- SII FOR OFFICE-USE: <br /> 6 <br /> ----- - - ----.... -- APPLICATION FOR SANITATION PERMIT Q Permit No.--��- <br /> - II <br /> (Complete in Triplicate) ' <br /> .................. . - --••-- •.. --- ------ ... <br /> Date Issued...._......... <br /> II I This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to t Ile San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in com 6lionce with County Ordinance No. 549 and existing Rules and Regulations: M <br /> JOB ADDRESS/LOCATIO . ._..7. il/.�... _ _ - .--------.....CENSUS TRACT.. --- -•........ .............. <br /> t :. , .. ./4.. !d!l._ hone 's�f�b <br /> Owner's Name.. ----- =......... '.S� <br /> . O. 8 <br /> Address......................... . 1. �'.9-�-...---•/- City - - Zip - ...._.... <br /> Contractor's Name----.--..:•- T .......................License #. 55�.'3.5�3_ Phone ...... ...-91•Q.2__. <br /> Installation will.serve: .Residence X Apartment House.❑ Commercial E) Trailer Court E]r- Motel F- Other.........................:.... <br /> Number.of living units: ..,.. Number of bedrooms:.__✓.• ...Garbage Grinder............Lot Size ---- 2 -7 <br /> Water Supply: Public System and name.---'....:. .., .i......: . :.._,u.-.-•-.-., .: ----- ------ Private i <br /> Character of soil to a depth of 3 feet: , Sand D, 'Silt Q Clay ❑ Peat 0 Sandy Loam ❑ ;Clay Loam ❑ <br /> Hardpan❑ Adobe Fill Material ........If yes, type.. :............. ....... <br /> -j <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 Pu6iic sewer is available within 200 feet,) <br /> �" /x /�7r� -----Liquid De th._Sy'i t <br /> -Type -Material...`-�' r.-----No. Com artments. .........::...1------------.... 41 <br /> PACKAGE TREATMENT [ ] SEPTIC TANK lSize P <br /> capacity T e. �e- . p r� <br /> ! Distanc�e'.to.nearest: Well._. _100..........................._.Foundation.._./0_.:t-----------Prop. Line_S-.. ------ <br /> LEACHING LINE [ No. of Lines----------- _ ....Length of each line._.___�.5 _ --------- <br /> Total Length..._..�.�_Q.. t <br /> --- <br /> 'D' Boxl..: ._L--"fype Filter Material.._f".- ..Depth Filter Material------------ 61 ----------- ----------- <br /> - -� <br /> r j <br /> Distance to nearest: Well_.__��P. t__:.....Foundation__,.l.Q.._ F'....:.-.Property Line......4�..... .........:.... i <br /> SEEPAGE PIT [ Depth. i ..4 (_.Diameter. �� .. - �r ❑ <br /> / _ ... ._ Number_..,.....-� _.__.'.._.._ Rock Filled Yes No <br /> Water Table Depth . .......:......:....... �_. <br /> Rock Sizer -------------• ------ <br /> Distane to nearest: Well _..�.�- -------- <br /> --------- --• lD'_ ... ` Prop. Line__...__-- -- . <br /> i <br /> ...Foundation_.... _..__"� -S j-- <br /> REPAIR/ADDITION (Prev-. Sanitdi'tion Permit*. ------Date...... ........ .---) <br /> - ... <br /> Septic Tank (Specify Requireme nts)....... ........... --------- ........ ........... .........­­........ .......................... ........ <br /> Disposol Field (Specify Requirements).... -_._.. _- ------- ----'................ . . ......................... .......................................... ... <br /> .............. --•.... ... .................... .................................. ;r <br /> f ................................... <br /> -.. ..--------- - --------- -••--------------------------•-•--- -_ ----- <br /> I <br /> (Draw existing and required addition on reverse side( ' <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County � <br /> Ordinances,, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following���� t <br /> "1 certify that in the pwformakce' of thework for which this permit is-issued, l shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> .............. <br /> BY............ ..... _.._ ............,Title.....:.. :._ <br /> f othe? than owner) <br /> • + FOR DEPARTMENT USE ONLY I <br /> APPLICATION ACCEPTED BY...! ............. ..................:..... ..........-...... ...... __DATE .._.._ :. = ......... i <br /> DIVISION OF LAND NUMBER/r- .................................:::. ............. - -------- ---- -- DATE.:........... :_.......... : !. <br /> 1 <br /> ADDITIONALCOMMENTS..... ...........................••...:.......... . ...................... -------•- ..... ........ .--••-----•--••-•-- .A............ <br /> ------`---- . ....---•••-------------------•. --.............--- -•--•-•----......--•...... ....................... - . <br /> �.. ' <br /> =� = ----.....--- . ...--•--------•................._ : . .....---- -- _ ..... <br /> { n• . ... .... ~ <br /> ----- ----- <br /> _ <br /> Final Inspection b �!.......... ........ ... ............. .....----------•---- '......Date - • <br /> FREV7176 3M <br /> EN 13 24 d`� SAN JOAQUIN LOCAL HEALTH DISTRICT a . <br />