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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT /� <br /> Permit No. t <br /> (Complete in Triplicate) "" ............ <br /> ............... This_Permit Expires 1 Year From Bate Issued Date Issue ......._..._......., <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/LO ATION .. l_ --------------••--•--- -- ---� ------CENSUS TRACT _...---------....... <br /> .._.__ <br /> Owner's N me __: .. :t•-:_��:� ... / /1•?--LL................. ------. ..... -------- ............... ...Phone.................................... <br /> ddress __ ..``.. �' k ! r <br /> G^ �. ._. �rtC2G.J(!_�-�} f_ .> _ �City ._.._... �`Q { <br /> ----------------------------------------------- <br /> A /Contractor's Name --- A.—I—. ± ...._'rte... < 0.1 Phone <br /> Installation will serve: Residence[Apartment House fl Commercial:[]Trailer Court <br /> Motel.D Other-•------•----------------- ----------------- <br /> Number of living units_____________ Number of bedrooms ...15.-_._Garbage Grinder ._. .._-_ Lot Size _��.A90PS.--__.__...._.-.___ <br /> Water Supply: Public System and name --------------------------------•............................................................................Private$ <br /> Character of soil to a depth of 3 feet: Sand El Silt{] Clay [] Peat❑ Sandy Loam [2 Clay Loom-Z <br /> Hardpan[] Adobe Cp Fill Material ............If yes,type....................--------- <br /> (Plot <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 public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ J Size................................................ Liquid .Depth .-_. - <br /> Capacity----------------•--- Type .................... Material...................... No. Compartments ------- ------ ---- <br /> Distance to nearest: Well ------------------------------------Foundation --------------_---- Prop, Line-----.___..____.------ � <br /> LEACHING LINE [ j No. of Lines ........................ Length of each line..__---._...__._-.-__.___-__ Total Length :_......._.._.___..._••--_-- � <br /> 'D' Box ------------- Type Filter Material ....................Depth Filter Material ._.---..................._.................. -� <br /> Distance to nearest: Well ________________________ Foundation ...................._... Property line. -------------_--_----- <br /> SEEPAGE <br /> __._._-._---_-- .____.SEEPAGE PIT [ ) Depth _................... Diameter ---------------- Number -_-_._...__-_--_._____...._ Rock Filled Yes [] No �] <br /> Water Table Depth ............................--••................Rock Size ............................... <br /> Distance to nearest: Well ----------_..........................-_..Foundation .................... Prop. Line ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit _.______.;___________ ______________________ Date __..... _._•. . <br /> ly- ' ,r <br /> Septic Tank [Specify Requirements) ..... . .. tC r / _ - <br /> Disposal Field (Specify Requirements) -G1!1'4W.... ~ <br /> ----------------------------------------------..................................................................................................... ------ ••---------- <br /> -•--- ---- -------- ........................... ........_-...---------------------•------------------------•-------------------------------••---•......I.....•....... ----------- ................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this applicatlon 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 /> By - �Ca'..-i _ ._-• ....................................... Title ` I..... <br /> (If other than own <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- -'CDATE- rcz."'_�1_:. �. <br /> BUILDINGPERMIT ISSUED ----•....................................•---.....-•---•-----•--...-•-•-- --------------------------------DATE -------------•-----•-----------•----------- <br /> ADDITIONALCOMMENTS----------------------- ------------------- ---------------•------...........---•--................_..... ----------------------------------------.........._:. <br /> ................... ----------------------------- <br /> ------- - -- ---- -L ------. <br /> Fina) Inspection by: �y . ---••-•--•----------------------------------------------------------------------- <br /> ••---- - _...----------....._ Date _ 1 ---•-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r E. H. 9 1-'6H Rev, 5M <br /> 1 <br />