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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ........ Permit No. .7-�":��2- <br /> (Complete in Triplicate) <br /> .......__.. This Permit Expires 1 Year From bate 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 Ordin nce .No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIOl/ ....�.... _ . '�. p •✓� ......................CENSUS TRACT ............_.._..._...... <br /> Owner's Nome ....... ............. ... j. .. -- •--.Phone . /'2 f.6.......... <br /> Address ---------------•- ....... / _ - 1._F-t. City _. ....... -- <br /> .. ....... . <br /> Contractor's Name -S 'lam✓....:...........License #, ''` . `f.3.... Phone ' 6d.7..... <br /> if <br /> Installation will serve: Residence. X Apartment House C] Commercial ❑Trailer Court ,❑ <br /> "' Motel❑ Other ...:_._.... - _----------- <br /> Number of living units: ........... Number-of `bedrooms ------------Garbage Grinder -- Lot Size ............................................� <br /> Water Supply: Public System and name.. ........................................ ..........................-_.........------------------Private ❑ `t <br /> V <br /> Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑.Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material _........�Ifyes,type ............................ W <br /> (Plot ,plan, showing size of lot, location of system in rel t on.,to weli6clings; etc.. must be placed on reverse side.) <br /> � ,»„ <br /> NEW INSTALLATION: (No septic tank or seepagepit�p m tted ifipvblic s wer is avoi able within 200 feet,) <br /> PACKAGE TREATMENT { } SEPTIC TANKiI } i ,size........... ..--�---_-- ..................V Liquid Depth .-..-.•---.-...-........,. <br /> Capacity .. Te ----------- MateriaNa�. Compartments .. -------- <br /> ..4?--- <br /> Distance to;; nearest: Well . .::V-.. Foundation ......:.... ....... Prop. Line .............__.....:. <br /> t � <br /> D"'Boz ._.... - T - <br /> I---- •- , ....... Tota length _..._............... <br /> LEACHING LINE [ ] No. of Lines i Length of each Iine . ..- <br /> $__.__ r _-----Depth: Filter Material _. <br /> ape, Filter Material"`""`.___..__ _ <br /> -44 <br /> Distance to nearest: Well . ........... .... . Foundat on __.�......_..._._.... Property Line -_--_.--._-....._._.... <br /> I <br /> SEEPAGE PIT [ J Depth Diameter ............:... Number _.:...... _-----------.._ Rock filled Yes ❑ No [] <br /> Water Table Depth - _._... ......--•.......... ......I----_Rock Size -- ...------.-_------- _-_ <br /> K <br /> Distance to nearest: Well ---------••------ ----- L...Foundati� .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..._.__.,; .................. .-_- Date ----._._.........................) <br /> Septic Tank (Specify Requirements) .......... /........ .......#---•_-..- <br /> ,,��11 ������ --... - ....---•------•....................•-•-._.....---------.......... <br /> Disposal Field {Specify'R q rements} ..._ ..4�'-----.4_ le-C.ef_.. - <br /> d. <br /> ` ............. ........ ------ --------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared fhis�application�and thatithe work will be done in accordance with San Joaquin <br /> County Ordinances, State laws, and Rules and .Regulations of the Son 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 whi#h this perlit is issued, I shall not employ any person in such manner <br /> as td become subject to Workman's Compensation laws of California." <br /> Sign d ....... ---------------- Owner <br /> .. _ _..�. <br /> BY - ...... . Title <br /> .............................. <br /> It oth an owner) <br /> FOW DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B _ :M ..+ _. DATE f .-? ............. <br /> BUILDING PERMIT ISSUE _ .._.. . ----­-------- .......... ..........:...DATE ................................ <br /> ADDITIONAL COMMENTS ' ... / . ....-•-----------------•------.._....---................---....._. <br /> f ---- ---- ----------- ......... <br /> .... �---•----• ------------- <br /> _ __ _ <br /> j Final Inspection b <br /> P y: ........ r: ' - ---------------------­-------•...-..... ........_.....Date _. �.------- --------- <br /> - .. -SAN,JOAQUIN LOCAL HEALTH DISTRICT• . <br /> e <br /> E H 11,14 <br /> 24 f"; 58,.-NO-.5M 7/723.M <br />