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FOR <br /> OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> .................. ............................... ��(t arnplets In Triplicatat �. _ Permit No. .. '�� <br /> ..................................I ........ .. .... This Penult 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. 5' 9 and existing Rules and Regulations( <br /> JOB ADDRESS/LOCATt �• ....... . ....CENSUS TRACT .......................... <br /> Owner's llama �� � ""�r. �. .. .................................................phone .................................... <br /> `Address .............' (S . ............ ........... ....................... . . <br /> Contractor's Name ' «� � - <br /> --••��... --- ... -- •----••--•........... .................!.!cense ���� ���Rhone - �:.� ` <br /> Installation will sLa: Real nee Apartment House❑ Commercial❑Trailer Court ❑. , <br /> Motel 0 <br /> i:: Other............................................� <br /> .`- -.._ Numbed-of be�raroms -.---Garbage Grinder/". ...... Lot Size ............................................ <br /> Number of livinj un <br /> Water Supply: Public Sysii and name ... .............. _...-------•..-......�...... .........................................Private <br /> Character of soil to a depth of 3 eet:—Sand❑ silt --,,,,,Clay ❑ Peat'[ &3ndy Loam ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe❑ Fill Materlol ............If yea,type ............... ............. <br /> (Blot plan, sh'ling size of lot, iocation .o#3-system fi! ,retatfon to wells, buildings, etc, must be placed on reverse side.) <br /> NEW iNSTAELATIONe [No septic tan or seepage pit permirted 1# public sewer is available within 200 feet,) <br /> PACKAGE TREATNIENTR {Lj SEP'fl�T/_NK j ] Size--••- •...........................•-.•-----.... Liquid Depth ..._...._................. <br /> � r <br /> Capacity II ..__tel Material...................... No. Compartments :....._..}� <br /> pa ty I pe - y <br /> A Distance to nearest: Well .1". .A....................... bundp�t o .f!1.._._.__._.... Prop. L1� <br /> ....... <br /> LEACHING L14 [ No. of Linea g T g <br /> . Length of aeh line... t ................... Total Length ._.�................ _1 <br /> ,r <br /> 'D' Box ..�....... Type Filter Material ...Depth Filter Material .. <br /> Distance to nearest: Well ........................ oundatioh l....................... Property Lina................. ...... <br /> i SEEPAGE PIT [ Depth .................... Diameeter ._....._... .... Number .. .....................- Rock Filled Yes'❑ No ❑ . <br /> Water Table Depth ----•----•......................................Rock Size _._...................4......... <br /> # Distance to rtendati . Prop. Line ........._......... <br /> ,r. REPAIR/AQQITION!Frau. Sanitation Permit# .. :y '4Aat`e . :: ::.. .................•� <br /> l Septic Tank {Specify Requirements) ......................................................................................._............................. . <br /> ----• <br /> Disposal Field jSpbcIfy Requirements) ........... <br /> ....................... ... L . ....................._...._._..- ----._..::...............----- •..............--.---...._......_............_...................................... ..... <br /> r . . .......................... ........................._....------................_ . <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify fl at have prepared this application and that the work will be done In accorJance with Sar Joaquin <br /> ! County Ordinances, State lows, and Rules and Regulations of the San Joaquin Local Health District. Home owner or <br /> Neon-sod agents signotgre�ertlfles the following: �1 <br /> "1 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 ta.becom sub ecto W n's Corn sation laws of California." <br /> Signed... . ...... a ....................................I......... Owner <br /> By -----`--- ---------- <br /> (if other than owner! <br /> FOR,"PARTMENTUSS&NLY <br /> APPLICATION ACCEPTED BY .... rt`................... DATE . ...: ... <br /> BUILDING PERMIT ISS1fED <br /> ........................... .... <br /> ..DATE _:..::_:. <br /> ADDITIONALCOMMENTS •........................................... ............................................................................:........................... <br /> ................. ..................................... ................rr.:..-...._.._.......---.....-------........--....------.-----........ <br /> ......... ..... ....... .. ..... ..• --- <br /> ... . . <br /> *� <br /> Final Inspection by: .....-Date ..a <br /> . . ... . . <br /> IFI 13 24 1-68 Rev. 5m SAN J AQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />