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FU" APPLICATION FOR SANITATION PERMIT <br /> ..... ................................................... Permit No. .7.....I....... <br /> (Complete in Triplicate) <br /> ........................ Date Issued ........... <br /> a <br /> This Peimit irx ares ! Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constrict and Install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> 0011.1 <br /> JOB ADDRESSAOCATI K .. l c .- `• e .Y. �! . � . .0`. . r, C .....-t'ENSUS TRACT .......................... <br /> Owner's Name ..._--...lC� �, .. -` .................................................. ............-,.Phone .94F6."-3s C)...... <br /> Address ........ �/•�• ,�• ��:!J P�' . L.......................................City . . c G.v ._.................._...................... <br /> Contractor's Name ......--- b-6.4fp `--•.. ..........................................License # ....... . ............. Phone .............................. <br /> Installation will serveh Residence Apartment House❑ Commercial❑)Taller Court ❑ <br /> ii Motel [3Other <br /> Number of living units:-----J-.... Number of bedrooms .... ._Garbage Grinder............. Lot Site ...I.. .......... - <br /> Water Supply: Public System and name ......................... _...................._........................................---..._.....Prhrote <br /> Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam fl day Loam ❑ <br /> HardpanX Adobe❑ Fill Material ............If yes,type........................... <br /> IPlot 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 ] Size................................................ Liquid Depth ........................... <br /> Capacity .................... Type .................... Material...................... No. Compartments ---..................NA <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 ............................................ <br /> Distance to nearest• Well ........................ Foundation ........................ Property line ...................... <br /> SEEPAGE PIT ( } Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑ <br /> WaterTable Depth ................................................Rock Size ................................ <br /> Istance to nearest: Well ........................................Foundation .................... Prop. Line ..........-...........r, <br /> EPAIR/ADDITIO . Sanitation Permit# ............................................ Date ..................................I <br /> Septi_T ark (Specify Requirements) .......... C{�. ..././.��-'•,«N'�'�...........-���:.... ..... <br /> Dlsloosal Field Specify Requir ants} �.-._! = <br /> IF .. Y. <br /> 7 ---------------------•--••..... ............................................. ...........................................--�. <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 acceWana with San Joaqul <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Herne owner or lic <br /> sad agents signature certifies the following: <br /> "I certify that in o performance of the work for which this permit is issued, I shall not employ any person In such manner <br /> as to beta sublet ,Work Compensation laws of California." <br /> S:gnG ...... ............................................ Owner <br /> .............. ...................... litle .........................................-............................ - <br /> �� f,o t a owner( <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .......................... DATE ••-• <br /> BUILDING PERMIT ISSUED ...................... ....DATE=-:....-................. <br /> ADDITIONAL COMMENTS ...... .................................................... - <br /> ........... .............................................. ----.........-._.. ........-........ ................................................ <br /> ........................--.-.................:.............---........................................- .................. ...... ..-.. <br /> , ........ ................... . .... <br /> - <br /> FinalInspection by: ....... ...............C e- l...--....------------...................._.__...-............-•--..... .........-.Date ..- .... � . ..7�....-.-........ <br /> EN 13 2!t 1-611 Rov• 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />