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FOR OFFICE USE: pppLlCAgiON FOR SANITATION PERMIT <br /> Permit No. -7 <br /> (Complete in Triplicate) _ <br /> - ------- ---------- ---------- ----- �. T"'� - Date Issued �----------------- <br /> in <br /> ---��---7. <br /> This Permit ExOires i Year From Date Issued <br />} A ' lication is hereby made to theSanJoaquin 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. 49 and existing Rules and Regulations: <br /> S -------------CENSUS TRACT --------------------•----- <br /> JOB ADDRESS/LOCATION - r-- - <br /> �` ` -___� <br /> _._ Phone --- -- ----- <br /> Owner's Name 3 `---------------------- <br /> City <br /> ---------------- <br /> Address ------------------ <br /> " ` -------License #o�G_°�'�A,l--�- Phone <br /> Contractor's Name ._ _ s�{�s�---- - --" <br /> Installation will serve: ResidenceAApartment House'❑ Commercial ❑Trailet Court l❑ <br /> Motel ❑Other ---- ---------------------------------- --- <br /> arbage rinder --_. <br /> ''—&--Lot Size -----`�------- - -------->----•----•- <br /> Number of living units:- - _ Number of bedrooms __ <br /> (�4�-" ---------------------•-----._Private ❑ <br /> Water Supply: Public System and name _-_-7`"--�-- ---------- ---- - --�- - """--"-""""""""""""-�" <br /> Character of soil to a depth of 3 feet: Sand'F] Silt ElClay ❑ Peat E] Sandy Loam El Clay Loam [I <br /> } Hardpan ❑ Adobe* Fill Material ------------ If yes,type ---------------------------- <br /> I lot location of system in relation to wells, buildings, etc. must be placed on reverse side.] <br /> { {Plot plan, showing size of Y <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> 1 SEPTIC TANK 4r/10'/` Slf' ------- Liquid Depth _ <br /> PACKAGE TREATMENT [ ] [ � /.�.�`• Si e- ------------- ----------- ----•--- - <br /> q -- <br /> Capacity - Type -------------------- Material----------------- ---- No. Compartments ----------------.:. <br /> Distance i to nearest: Well ---------------------'--------------Foundation _______ --------- Prop. Line ---_--_- .___.."_-• <br /> _______ Len th of each line_ _Total Length --------------- <br /> r <br /> LEACHING LINE No. of Lines ---- ------ g <br /> 'D' Box ." ".-- Type Filter Material r; kx ---Depth Filter Material ___ - '---- <br /> Z Foundation t�_f--------- Property Line -- ---•---._-.... <br /> � pistanceao nearest: Well �d-_____-__-_____ ----� - <br /> r` �. _ � Number ----.---a-------------- Rock Filled Yes ' No iG <br /> SEEPAGE PIT Depth "a ------- Diameter <br /> ---- Rock Size <br /> Water Tdble Depth ---- ----�C7--------­,;--------•- f► <br /> I Foundation 'Of----- Pro Line _. ------- <br /> Distancelto nearest: Well _____1Cpa------------- p' <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 <br /> Septic Tank (Specify Requirements) -------------------- - ---------------------------------- <br /> Disposal Field {Specify Requirements] ____________ ___ ----------------"------------ <br /> --------------------------------- <br /> ---------------------------- <br /> ---------------------------------------------------==-------- <br /> I - --------------------------------- ------ <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 perforrnance 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 /> I Signed ----------- ---�--� Owner <br /> �; <br /> �•` :__. � Title _. <br /> I {If other than owner) <br /> i FOR DEPARTMENT USE ONLY <br /> rr <br /> i APPLICATION ACCEPTED BY ------ ----------------- - ---------------------------------------- DATE t <br /> -- ----------=------------- - <br /> BUILDING PERMIT ISSUED _.__ DATE <br /> ---------- <br /> ADDITIONAL COMMENTS ----- --------------- <br /> ----- - <br /> - --- ------------------------- <br /> --------------------- ---- ------- <br /> ------------- ------------ ---- ---- Date ----- <br /> - -- - <br /> ------------- <br /> --- -- ----- -- -- ----- <br /> Final Inspection by: . ______"--___"-- .- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 .1-'68 Rev. 5M. < <br />