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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit NO. ..7�...•--..... <br /> ..........-..................I.••-•:............... .:.... <br /> (Complete In Triplicate} ........ <br /> This Permit Expires 1 Year From Date Issued Date Issued .,7:./..5:. 6 <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 /> JOB ADDRESS/LOC N <br /> - ... _... . CENSUS TRACT .......................... <br /> .. .. <br /> Owner's Name ------- <br /> .......... ........................... ..................Phone ..........................--_-- <br /> Address r <br /> 1.. _ ..: .......... ...... city .......... .....ti..................................................... <br /> Contractor's Name ---- --- i,� _._ ... --�� ...----..License # Phone ....................... <br /> Installation will serve:: Residence [ Apartment Douse 0 Commercial❑Traller Court <br /> Motel ❑Other .....----•.......:..........•---------•..... <br /> Number of living, units:_--_- Number of bedrooms -.y..-Garbage Grinder _--- ....... Lot Size _. ......... ...-........ <br /> Water Supply: PublicSystem�ohcl nave ....... ............................................'. ------•-------..••...............--- ... --..........Private <br /> Character of toil#o-a depth of 3 feet: Sand ❑._. Silt❑ day ❑ '•Peat❑ Sandy Loam Clay Loam D <br /> `} Hardpan p Adobe 0 fill Material ............ If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system- in-relatlon"`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 I'] SEPTIC TANK I I Size.....................� ' ... Liquid Depth <br /> Capacityyp : Material.....:............... No. Compartments <br /> T e <br /> F Distance to nearest: Well ...................................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE l ] No. of Lines ------------------------ Length of each,Vine-.......................... Total Length ........................... <br /> 'D' Sox .......... Type Filter Material ....................Depth Filter Material ............. ........................ <br /> Distance to nearest: Well ___.................. Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT j Depth Diameter, ................ Number ............................. Rock Filled Yes ❑ No 0 <br /> WaterTable Depth ..........................••-•..................Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation ............ ....... Prop. Line ...................... <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ........._.................................. Date <br /> Septic Tank (Specify Requirements) .. - �...................... .............. :�? <br /> Disposal Field (Specify Requirements! .. _,,f�t,_ �: �..... ...... - ' � "" <br /> � . <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 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 /> B /� •_......_. .. Title ! - <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ -.-- - - DATE ------------ <br /> BUILDINGPERMIT ISSUED ---------------------4.0--_-------------_.................... --_---------- --- .....------------.DATE ... --------------------- <br /> ---------------- <br /> ADDITIONAL. COMMENTS --------------------------------•---- --•--••--- ................................. - <br /> ---------------------------•---------------- <br /> ------ •�-- }-�-- r� <br /> Final-Inspection by: ------- 7h� -- ..1-.e-.... .........•------- <br /> ��f'�..XSAN <br /> ....------------...__.........__-•-•------•----..... ---..__ .._ _.. ....----..Date . .. _ ... <br /> Eli 13 2!� 1-6i3 13e'sr. JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3H <br />