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I � � <br /> i . <br /> FOR OFFICE USE: II FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT p <br /> -------------------------------- ----- Permit No.,7 <br /> (Complete in Triplicate? <br /> i --------------------------I-------------------- q <br /> 1 Date Issued.✓"-.T-7/ <br /> -- ----- '____-__..- This Permit Expires I Year From Date Issued " <br /> II <br /> Application is hereby made to the San Joaquin Local Health District for a permit;to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and-exist.ing Rules and Regulations: F <br /> ,..r <br /> CENSUS'TRACT - ------ <br /> JOB ADDRESS/LOCATION ��m:""" _"" ----- <br /> Owner's Name---."- - - -�+'+--- = on <br /> Ph e_ <br /> Address.... - ?11 . __ � 5 ---- � City R ZAP <br /> i <br /> Contractors Name---- 1 C7 -------------- cense # .-------- <br /> p <br /> ---- Phone <br /> - � '� ..;. � �� ...E , <br /> Installation will serve: Residence I Apartment House.❑ Commercial [] Trailer Court ❑ �- <br /> Motel '-Gther -�­._ • _ <br /> Number� r of living units:-_- S'Y _Number of bedrooms- .__Garbage Grinder-------------Lot Size---------------.----------:__- -_---------------------------- <br /> Wa#er Supply: Public System name - ----------`----------------------------- y ,-. = Private <br /> -- - - <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay❑ Peat ❑ Sandy Loam ❑ Clay Loamle <br /> ,' p ❑ , ❑ ---- Y type- °-------------- <br /> Hard an Adobe Fill Material._.._ ._ If es, t e_-__, <br /> (Plot plan, showing size of 1 ut, 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 ' [ ] Siie------------------------------------`""-------------------Liquid Depth.--------------------------C <br /> � E <br /> Capacity--==- _---- =Type---------=---- -=-.._Material- --------------------�..-_No. Compartments-------------------------------'---- <br /> Distance to nearest: Well.--..---.-.--------------------------------Foundation-------------------------.-Prop. Line---------------------------.-- <br /> LEACHING LINE [ l No.11iof.Lines_._,___..____-------_ , Length of each line_________________F ---------Total Length.0'-------.___._________- €_ <br /> II b, <br /> ] D' Box------------Type Filter Material------------------ -Depth Filter Material--------------------- ----------------------------- <br /> 'Distance <br /> -----------------------. . . � r, <br /> 'Distance to nearest: Well- ------ -------------------Foundation---"------- --:'----;..___Property Line--------------------------.--------. <br /> y, .H <br /> SEEPAGE PIT [ ] Depth----------------Diameter-------- ---- -------Number------------------------------------ I Rock Filled -Yes❑ No ❑ <br /> Water Table.Depth =------=-------------=-------------=------=----- ----Rock Size------- -------------------- '- ----=------------^ a <br /> Distance to hearest: Well---------------------------------- ------------Foundation,.;-------------------------Prop. Line---------------------------. <br /> REPAIR/ADDITION (Prev, Sanitation Permit#--=------------ -----------------------------------Date------_•------------------------------- -,-----) <br /> Septic Tank (Specify Requirements)____.___-_-`_______ ______ r - ---------- <br /> I�. <br /> Disposal Field (Specify Requ�rements):__._[ ,� - ------------------'------- <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 County <br /> Ordinances, State Laws, and Rules and Regulations of the' San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: <br /> t it <br /> "I certify that in the perfor'm.ance of.fhe work for which this' ' ermit is issued, ;I shall not employ any person in such manner as <br /> to become subject to Workman's. Compensation laws of California.'.' <br /> Signed--------------------- ---'--------- -. - ---- ---- . _ <br /> I . . . . - ._. !,.. _._ t . <br /> li �a <br /> caner, ,: <br /> (If other than owner[ <br /> FOR EPARTMENT USE ONLY; I <br /> APPLICATIONACCEPTED BY----- --:-- ------------------- - ------ -----=---------------------- ---------------------------- ---DATE -------------- - --:- ---------------- <br /> DIVISION OF LAND NUMBER --------DATE DATE _ <br /> . .. <br /> ADDITIONALCOMMENTS-I�--------- -------- --- ----------------------------------------------------------------------------------------- ------------ ------ ------------------ <br /> [ l) . <br /> -------------------------------------- <br /> it IIII <br /> --------- --------- <br /> -------------------------- <br /> ----------------------------- <br /> ----------------------------------------- <br /> ----------------------- ------ <br /> ------------- <br /> - ------ ------- <br /> --------------------------------- <br /> - . ----------------- <br /> ----------------------- <br /> Final-inspection by.----.---.--- _ - --- ---- ---- --------------------------------Date...l =---------------- - <br /> EH 13 24I� SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. ���6 3M <br /> II <br />