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FOR OFFICE USE: � - <br /> APPLICATION FOR SANITATION PERMIT <br /> 1 Permit No. --._...'........ <br /> . <br /> {Complete in Triplicate) r <br /> . <br /> ..... ......................... Date Issued .t� <br /> . <br /> ii This Pe Expires 1 Year Prom Date Issued <br /> 1 <br /> I <br /> Application is hereby made to the ;an 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. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIO <br /> .�f ... _ .... �: .:: _11 ::.�� .................:CENSUS TRACT _..._Z_.;..........._... <br /> o ..-• --... <br /> h ne �o �! <br /> Owner's Name -•-.-- --••----- -� - - - <br /> Cit ---- <br /> Address ............:......... ...�- � - - -----.--._.. .. . .......... <br /> Y ..... <br /> Phone <br /> Contractor's Name ------ ►`. /i- -�^-t5.--. e9 -"--- ---- License # r� :3. ... 6'�r6!!7_..... <br /> installation will serve: Residence ❑ Apartment House'❑ Commercial ❑Trailer Court j] <br /> Mote! ❑ Other ..... .. . ..............._ ® <br /> G ...r .:........ <br /> Number of living units:_....._... Number of.bedrooms .-?..Garbage Grinder -........... Lot Size ...�---•---•••• <br /> Water Supply: Public System and dame .....-.-_-_-._-.._._._. ---_--• <br /> ...........Private o <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑)..Clays❑ :Pea#r] Sandy Loam ❑ Clay Loam 0 <br /> Hardpan [J Adobe Fill 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 k or seepage pit permitted if public sewer is available within 200 feet,) <br /> t i <br /> PACKAGE TREATMENT [ } SEPTIC TAN F' Size---....��..-- -- --- Liquid Depth _S .---••••---- e <br /> Capacity Type _ ..i.._ Material_: _.. No. Compartments ...................... <br /> i <br /> t <br /> Distance to nearest: Well - ..--�..1 -:-.. -- - Fqundatio`...��...:.......... Prop. Line .. ---.dr._... <br /> Len th. of each line..., . <br /> Total Length ..I-� ..__... . <br /> i LEACHING LINE �Q No. of Lines -.... t �� p tr <br /> D' Bax ✓_. Type Filter Mate gal .1 -[. -------Depth Filte l Material .......I ------. ••-: _-57� <br /> rfl. --—-- Property Line ... -----.- ..' <br /> p mr <br /> Distance to nearest: Wel! _.:.,1�'"f.:-.- Foundat.�on c,;,.. ..r. - - �,• <br /> r ca -----:... <br /> Rock Filled Yes No ❑ <br /> SEEPAGE PIT [ Depth .Diameter .. 12 rNumber .. r, <br /> I Water Table Depth ..--- 4 ock.Size�_f <br /> ------• _._ .K l_11---••------ s s{ <br /> t ; <br /> ;f'.............Foundatibn .::.1 '.. ....... Prop.jLlne .................... <br /> to nearest: Well ..._..�---�.�=.------ � 0{�� � v� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------ --------- -----:....... .... Date ------------ •--•-`• <br /> )C'l <br /> Septic Tank (Specify Requirements) . ._....... - --- .-....... _:_.... Y -- k ._ ..._ <br /> i - t <br /> k Disposal Field (Specify Requirements) ---------------------------------I------ - ------ -- .----------- ----------- <br /> :_ -- - ............ <br /> ............ ..... •..--------.. _ ----- ---------- r ----•......... ---........... <br /> 1 (Draw existing and required addition on reverse,side) • <br /> I hereby certify that I have prepared this application and that the work will ibe done kin accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Jo�uml,ocal Health District. Home owner of licen- <br /> sed agents signature certifies the following: <br /> i "I certify that in the performance of the work for which this permit is issued, I shal of employ any person in such manner <br /> as to become subject to Workman's'Compensations of California.r <br /> Signed --- 0wn <br /> er," w' <br /> ..... <br /> - Title . . .:..... .. ...Y... ..... <br /> If o r than owner) € <br /> F R DEP TMENT 115E ONLY.:,� � _ <br /> - � DATE ...... ..�� ..7.,J <br /> APPLICATION ACCEPT I=D BY .. ._ c.= - <br /> BUILDING PERMIT ISSUED .-...._-­­ ....... "` --- ------•--------- _-. >= •-...'.._..........DATE... <br /> I :.._.�. <br /> ADDITIONAL COMMWT ... ......:.... ,�• r r .... <br /> ...------ --_ <br /> . �;4.- <br /> - � c�ra /2:r/�l -� �� �� :zG ..................... <br /> :.._ . <br /> .......................... <br /> .._. ...... .__ i <br /> �� .�............. �- -- --•�:r_-------�----.`.L.�_..Date _.�.. _ ... <br /> Final Inspection by: . ................ ....,,..... c c i �✓ r- � ... <br /> WL SAN JOAQUINLOCAL HEALTH DISTRICT v <br /> ti X7./72 3-114 <br /> .ce, n_.. cu <br />