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a <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> - - ------- ---------- --- Permit No: -------^------------ <br /> (Complete in Triplicate) <br /> .i <br /> ---- <br />► � Date Issued <br /> i This Permit Expires 4 Year From Date Issued <br /> I <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/LOQ ON _ f_ ` -,-.�1-j�AM _v__�c-_-�-----i- _1_ CENSUS TRACT p------------------------- i <br /> Owner's /Name --- � ���il-� ���----------- ------------------------------------------------ ----------Phone -�T_-- ----- <br /> 27 <br /> Address C7�= 1� �� fZ,f?�------ -------------- - City �� <br /> -- ------ -- --- - ------------------------------------- <br /> ,!� 2/f '........... <br /> Contractor's�iName --�__--�-'---•1.--f=l�_�_f -------------------------------------License #��C���- ------ Phone _1��------- <br /> Installation will serve: Residence ❑ Apartment House-0 Commercial:❑Trailer Court 'E] <br /> Motel ❑ Other ------------------- ------------------------ <br /> Number of living units-----(_------ Number of bedrooms _____Garbage Grinder ------------- Lot Size9' ` <br /> Water Supply: Public System and name ---- --- -- - -------------------�-- -- - ----------------------------.-------- --- ------------------Private�ZJ' <br /> I <br /> Character of soil to a depth of 3 feet: Sand'[[ Silt❑ Clay ,❑ Peat❑ Sandy Loam .El Clay Loam ❑ <br /> 1 Hardpan ❑ Adobe ❑ Fill Material --------.--- If yes,type -------------_-------------- <br /> ,4,j <br /> _____________, ; E� <br /> -f -'(Pl'ot'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:[ I Size-- ------------------- ------------------------- Liquid Depth ---------------------.----- <br /> Capacity -------------------- Type ---------------- __ Material --------------------- No. Compartments <br /> Distance oto nearest: Well -------------- ---------------- ---Foundation ------ --------------- Prop. Line ------------------- --' <br /> _ Len of each ane----------------- --- Total Length ------ --------------_---- <br /> 'D' <br /> LINE [ J No. of Lines __._____________________ g ------�- g <br /> D' Box _�_____-____ Type Filter Mat rial _________ _________Depth Filter Material ____________________________________________ <br /> pistance to nearest: Well ___: oundation Property Line <br /> I SEEPAGE PIT [ ] Depth -- ---------------- Diame r ___________- - <br /> Number __.------------------------- Rock Filled Yes ❑ No 0 <br /> WaterTable Depth ---------- ------------------ -----------------Rock Size ------------------------ <br /> Distance to nearest: Well ------------------ --------------------Foundation ---------_----------- Prop. Line ------------_---- <br /> REPAIR/ADDITION <br /> ----------___ _- <br /> 4 ---- <br /> REPAIR/ADDITION(Prev. Sanitation.Permit# ________________________________ _ Date ____---._____________.____________} <br /> Septic Tank (Specify Requirements) ----------------------_-----Fe------------11-17----e---------------- <br /> --------------- --- -------------------------------- ---------------------- ---------..----- <br /> ----------- ---------- <br /> Disposal 3Fie1 Specify Requirements) ----- -- _- ------ <br /> -- --- ---- - - ----�G.r - ---------- <br /> �r -------------------------------------------------- ------------------------------------------------------------------ <br /> p -------- --- -------------------------------------I-------------------------------- ----------- ---------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, cnd Rules and Regulations of the San Joaquin Local Heallh District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "1 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 tXm <br /> CompensatiZ of California." <br /> Signed .-- -- ----- -- a ----------- Owner• <br /> - ---- --------------------- ------- <br /> sBY - --- ----- Title ------------------------------ -------- <br /> (If other t <br /> O DEPARTMENT USE ONLY <br /> I APPLICATION ACCEPTED BY -___ ___-_-_____. DATE ___ `_'�.----__-- Y <br /> BUILDINGPERMIT ISSUED ---------- --------------------------------------------------------.-------------------------------------DATE ------------------------------------------- <br /> s ADDITIONAL COMMENTS ---------- ----------------------------------- ------------------------ ------------------------------------------------ ------------------ <br /> ------------------- <br /> i --------------- <br /> -- <br /> ------------------------- -- - - - <br /> -----------------------------------=----------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------- <br /> ----- ------- ----------------------------- <br /> --- - - ---------------------------------------------------------------------- ------------- - - - <br /> -- - - - ----- - ---------- <br /> Final Ins ection b --------------------------- ---------Date --.--- ---- .? _-.2,,i <br />