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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit Na: 7o, 36.6 <br /> ............ <br /> ................r...._..._.......... (Complete in Triplicate) <br /> .................................................. <br /> Date issued <br /> ......... This Permit Expires I Year From Date Issued <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. 5491 , 1 ting Rules and Regulations-, <br /> ENSUS TRACT .».......__-_------- <br /> JOB ADDRESS/LOCATION TION ....... <br /> . . <br /> Owner's Name ..................... .. ... .. Phone ._.»........".. ........__.».... <br /> . <br /> Address .9j-1---- city .................:_ --------- <br /> C� ------- ,y <br /> Phone <br /> Contractor's Name ez License # <br /> Installation will serve: Residence KApartment House 0 Commercial 71Troiler Court C <br /> Motel Other ...................... --------------- <br /> Number of living units., Number of b edrooms Grinder Lot Size <br /> Water Supply: Public System and name -----_ .. ....................._....................... ....Privatex <br /> Character of soil to a depth of 3 feet; Sand 1:1 Silt 0 Clay [I Peat!� Sqndy Loom 0 Clay Loom <br /> Hardpan F] Adobe X 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 tank or seepage pit permitted if puWic sewer is available within 200 feet) <br /> TANK --/ ;k>4 <br /> PACKAGE TREATMENT I I SEPTIC TANSize - - --/, S- <br /> ------- Liquid Depth <br /> Capacity TYpp Material.. No. Compartments Z�....... <br /> Distance to nearest: Well __....-!.'G". .................Foundation Prop. Line <br /> .. <br /> LEACHING LINE )< No. of Lines ....../__-._.._-------- Length of each line Total Length ............. <br /> -.171,414<, ., -.. <br /> 'D' Box Type Filter Material ­­­.......4...Depth Filter Material <br /> Distance to nearest, Well -foundation ........ . Property Line <br /> - <br /> .... <br /> SEEPAGE PIT Depth ........ Diameter ................ Number ....--- Rock Filled yes Q No C <br /> Water Table Depth .................... .............Rock Size -----------­-.-_-_---- <br /> Distance <br /> --------Distance to nearest: Well ..._......«......»...-.. ._..-Foundation ................ Prop. Lim <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...... Date _.__.__».................»_.. ) <br /> Septic Tank (Specify Requirements) ....... .............».........----.._...__..........-•-.-.._.____.__.._..__..__­....... <br /> Disposal field (Specify Requirements) ......»..»..._.....»__._..._......._, .......--_-_-..._.1.............­_­­......................... <br /> ......................... .................... .......................... <br /> .. ............. .......... --—-------------- <br /> -- -------.......- -1..................................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 accor"nea with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin total Health District. Home awner or licen- <br /> sed agents signature certifies the following- on in such manner <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any parson <br /> r 51 <br /> as to beca/To subject.I worko�n*s Compe tion laws of California." <br /> "* laws <br /> T California."`P1 <br /> Owner <br /> e ai,. <br /> Signed <br /> By . ..... . <br /> Title ............ ....................................... <br /> (if other than a er) <br /> FOR DEPARTMENT USE ONLY <br /> .................... ................. " 4 <br /> APPLICATION ACCEPTED BY .. ...... ............ ........... DATE 7 0Z <br /> BUILDING PERMIT ISSUED .. ...............DATE ....................................... <br /> ......_ <br /> ADDITIONALCOMMENTS................_.................................. ................ ............ .....__».,................ <br /> ---------------­­..................................................- ­­­­........ ......................_­ <br /> ....................................... ............;....... ...... .....................­­­.................... ........­­........... <br /> .............. ...... <br /> ................................. ----------.......... <br /> Final Inspection by, ....... _..........---_.»_».................................... _7­!�....... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-`b8 Rev. SM <br />