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EOR OFFICE USE. APPLICATION FOR SANITATION PERMIT <br /> f..........- Permit No. ..751 <br /> (Complete in Triplicate) <br /> ........................................... <br /> Date Issued <br /> .............. ............. This Permit Expires 1 Year From Date Issued <br /> .................... <br /> Application is hereby made to the San Joaquin Local Health District fora per to construct and install the work herein <br /> described. This application i r comp 'anc ith County dinance No. 49,9nd existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIONNSUS:. T .......................... <br /> 1 Ci: TRACT <br /> Owner's Name .. ... r .. ; . . ... .s.<.. .,... ..... - ............Phone ........................ ........ <br /> Address .J_�d _ CitY ............................ —...•-----••---...._..... <br /> ---.._...._. .....----- <br /> Contractor's Name . _.... �---- ; 4&...........License # a� � ."1'.... Phone .....................•. ...... <br /> Installation will serve: Residence ❑Apartment House-F] Commercial ❑Trailer Court ] <br /> Motel ❑Other ____- -- -"'^"'f .:- <br /> Number of living units----- Number of bedrooms ....`:"::.Garbage Grinder ------------ Lot Size ............................................ <br /> Water Supply: Public System and name ------------ ........................... : ---------.-.------•----............--•-••-----.----_.Private C <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay C] Peat Sandy Loam i 7 Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ------- .... If yes, type ............................ <br /> (Plot pian, showing size of lot, location.ofsystem in relation to wells, buildings, etc, must be placed on reverse side.} <br /> NEW INSTALLATION: (No septic tank or seep ge pit permitted if pub tic sewer is available within 200 feet,) ; <br /> PACKAGE TREATMENT SEPTIC TANK Siae _ <br /> [ } 17 .................... Liquid Depth 151 <br /> �. <br /> Capacity,�Q� Type .�..... MaFerial__l"�"�:-_. No. Compartments ___.��.....�.........,� <br /> Distance to ne rest: Well ----- P........................Foundation ...�Q_. ..._._.. Prop. Line ....__.__.._.---...... <br /> LEACHING LINE [ J� No.#of Lines ....-._._l........... Length of each line........ _p.. ... Total Length ..... A. ...._. <br /> 'D' Box ............ Type Filter Material .:.....`. .Z...Depth Filter Material ..../11*................... <br /> Distance to nearest: Well ------4~ Foundation ----J 4............ Property Line ................. ......� <br /> .. f. .. .'. N ! k <br /> [ Depfh ....�D__........ Z.. � Number ...... .................. Rock.Filled Yes [500, No <br /> Water Table DepthU .. ..Rock Size 1� , <br /> . Prop, <br /> Distance to nearest: Well .-•--.....�.....D .........Foundation __.. ....... Line .. ................ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -_............................ -. Date .......6.......................... <br /> ) 1 <br /> SepticTank (Specify Requirements) ..........................................................................................-..-.---_...-----....................:.--------- � <br /> DisposalField (Specify Requirements) -------•...................•---- -----------._.........--------------------------.................................................... <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 accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of'the San Joaquin Local Health District. Home owner or licern <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 /> BYTitle ___------------ <br /> /�.r !_ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY -•--- f r ..:r.•-------••..........................:....•-----•-•-••-•--.._._.__..........--. :... DATE .::':. ! . Z/.._ ...I,�—....._.... <br /> BUILDING PERMIT ISSUED ........DATE ................ <br /> ADDITIONALCOMMENTS ............................................................................----------- --------------........................ :...._.. .................. <br /> ....................................... ..........­­_11---------------•------ ------._..._.........---....-----...:__..... ....................................... .. .. <br /> ... - - ­----------------- <br /> ,�.�pp ...........Date /./ 6 <br /> FinalInspection by .. ................. .....................................•...........•--------------..._. •-- - -...../. ... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />