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FOR OFFICE USE: ��s � <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------------------------------- -- ---- ----- Permit No: <br /> (Complete in Triplicate) <br /> ---------=-------------- ---------------- <br /> Date Issued <br /> ---------------------_-----_--------------- This Permit Expires 1 Year From 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`. 549 and existing Rules and Regulations: <br /> /� f _ze.�/fJ <br /> JOB ADDRESS/LOCATION . 2_ --------------- --AY fico-_ -i-U-- - ------- --- 1 _CENSUS TRACT -------------- ----------- <br /> Owner's Name ------- -------- • -- -- -.-------Phone <br /> Address Q 1 W----- - - ------ ------ - ------- --- ( _ - -City '----- ---- <br /> r <br /> Name ------ ------ --------------- - �--eJ :-.License #/� 3y Phone ----------- <br /> Contractor's <br /> Installation will serve: ResidenceApartment House❑ Commercial :❑Trailer Court T❑ T T T TM <br /> Motel ❑ Other --------------------------------------------- <br /> Number of living units:......I-___ Number of bedrooms !�_____-__Garbage Grinder ___________ Lot Size -------------------- ------ <br /> Water Supply: Public System and name --------------------------------------------------- ---- --------------•--•-----------------------------------Private ' <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ F Peat❑ Sandy Loam ❑ Clay,Loam <br /> Hardpan ❑ _Adobe'❑ Fili Material ------------- If yes, type _._________________________ <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 public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK TX Size_57 4_.t 1o'-- `-------------------.-- Liquid Depth l -----------.---:.---- <br /> I' i__ Mafieria _ _- . __. No. Compartments <br /> Ca acct �J�Ot7 Type P - '4 <br /> Distance to nee st: Well -----_-_�___t-----------------Foundation ___/_Q-------------- Prop. Line <br /> 4 ii i i <br /> LEACHING LINE { �No. of Lines __--- Length of each (ine�P__--ga_ l* p_-__ Total Length moo_________________ <br /> D'3Box --- TYpe..Filter Material_..- -�---------Depth Filter Material ---�_----. <br /> Distance 'nearest:IWell __„__` ----- --- Foundation ____ C-------------- Property Line Z-____-_--_--__.----- <br /> SEEPAGE PIT [ ] Depth ____t7' ________ Diameter ________________ Nu mber _-_ _.______---- Rock Filled Yes ❑ No C3a <br /> Water Table Depth._.-__--_:--------- -`----------------- --------Rock Size ------------------------ -•---- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----.-----------•_-.. <br /> REPAIRJADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) --=---------------- -------------------------------------------------- ---•- <br /> Disposal Field (Specify Requirements) ----------------------------------------------------------- ---------------------------------------------•-------------- <br /> ---------- ---------------------------------------------- -----------------------------------------------------------------------------------------------------------------------=--------------------- <br /> i - - --------- ----------- --------------------------------------------------------------------------------------------------------------------:-------------- <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 accordance with San Joaquin <br /> County Ordinances, State Laws and Rules and Regulations of the San Joaquinuin 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 which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California.” <br /> Signed Owner <br /> BY ,--------- --------------- - title ._` "2 ' <br /> (If other than owner) f <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY r rtrc ------------------------- <br /> ------------------------------------- - DATE -7' '�e----------------------- , <br />` BUILDING PERMIT ISSUED ----------------------------- - - ------------------------------------------- - -----------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS --=------------------------------------------- ------------------ -------------------------------------------------- ------ --------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ ---------------------- <br /> -------------------- <br /> --- ------------------------------------ -------------------------------------------------- --------------------------- ----------------------------- -------------------------- -- ----------- <br /> ------------------------------- �'` <br /> Final Inspection by: t` " - Date 7--?�"."----�+ - ---------- <br /> r` SAN JOAQUIN LOCAL HEALTH DISTRICT <br />