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FOR OFFICE USE: <br /> �/ `` APPLICATION -FOR SANITATION PERMIT <br /> ----- ----/2-7"7-----�I--------��.,3 r7--- Permit No. ____7--- 7 S_L <br /> I� (Complete in Triplicate) ' <br /> �I- _q,�-_� _ \t > Date Issued --- <br /> _. ------.- --- ""- �``' "" `" This Permit Expires ] 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 /> �LOCATION .----- � -- - ----- -----------CENSUS TRACT -------------------------- <br /> JOB ADDRESS/ <br /> Owner's Name -------------- <br /> -------------------------------------------------------Phone <br /> b __"_p <br /> ------------- <br /> Address I� _ - -- - - -- -- -- --- --------------- City _? ------------------------------------------ <br /> ------- <br /> --- --= �s-a�ic ` _ <br /> ---------- <br /> Contractor's Name -- -: License #,��� l� Phone _ d- <br /> Installation will serve: ;Residence& artment House❑ Commercial ❑Trailer Court ;❑ <br /> / ' ------Jj'� � <br /> Motel'❑Other Garba a Grinder ____. <br /> Number of living units:___'-_ NumbeP>pf bedrooms _ • g Lot Size _____ --�" '-------------- <br /> Water�Supply'ilPublicSystem-and name's-_!---------------- -- ;----•-- -'-;--------------------------------------------- ---------... -----Private <br /> Character'of soil to a depth of 3 feet " `: S66d'❑ Silt❑ Clay ❑ Peat ❑ Sandy1oam ❑ Clay Loam .M <br /> `Hardpan ❑ Adobe Fill Mafierial -----------.If y s, type ---------------------------- - - r <br /> (Plot plan, sh wing size of lot, location of system in'relation to wells, buildings,—etc. 'must,be placed on reverse side.) �/1I <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer"is aVaiIable within 290 feet,) <br /> PACKAGE TREATMENT [ ] SEPTICTANK'� ize_"_-�� '__��'.r__.___----.`----"--- Liquid Depth ___- "______________ <br /> Capacity/9W*,a.-=-- Type----------- :-- Material __e_-o�_<--- No. Compartments ---------------------- <br /> r r -F- <br /> Distance to nearest: Well -_______ �__- --------Foundation _ _ _--___ Prop. Line ___<�'_;...__.....Q% <br /> LEACHING LINE No. of Lines ------------------------ Length of each line-------1k7J------------ Total Length .-J-0-0---- -------­ <br /> D' Box,. _5-�_ 7e Filter Material _ _.. <br /> Type -__---Depth Filter Material -----_ Ic _��--_-._ <br /> ' <br /> Distance-to nearest: Well ------- <br /> Foundation ------- _P_________ Property Line ________. ..__-____. <br /> SEEPAGE PIT Depth /'?�_=+_______,.Rock Filled o <br /> ---- ---- ---------- Diameter -"-=��----------. Number -------- - , .. ; YNo <br /> d.4 Water Table Depth ------------' Rock Size . =-Y--------- <br /> -`--- ------ <br /> E .�- - <br /> F Distance to nearest: 11 _.___._____--- ---- _._-�`-_---- Foundation !`-------------- Prop. Line .. ------------------- <br /> REPAIRfADDITION{Prev`,Sanitation Permit# --------.-------------------------------- <br /> - Date --------------------•--•---------- <br /> ` Septic Tank 'i(Specify Requirements) --------------------------------------------r-------- <br /> -------------------------- -------------------------_------------------------------ <br /> ' Disposal Field (Specify Requirements) ------------- --------------•---------------------------------------------------------------------------------------•--------------- <br /> I� ti -- --.-- ---------------------------------- •---------------------------------------- <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 clone in accordance with San Joaquin <br /> County Ord inances„State Laws, and Iful';s and Regulations of the San Joaquin Local Health District. Home owner or <br /> licen-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 to Workman's Compensation laws of California.” <br /> F <br /> 11 1 <br /> Signedjothr <br /> -------- ---- -------------------------=------------ Owner <br /> - ------------------------- <br /> BY I T __ ------ ---------------------------ite <br /> (Ian owner} t, ' ,.f <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION TACCEPTED BY .- - -- - ------------------------------------------------------------------------------ DATE ----- - la.-------------- <br /> BUILDING PERMIT ISSUED -- -- --------------------------------------------------- ----------------- ----------=---- ---------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS --- ------------------------------------------' ------ <br /> ---- - <br /> - ----- � ,- <br /> -- ---------------------------------- - ---------------- <br /> ---- - ------ <br /> + ��,c' ' " ►- -gra'.-`s - - !°r'! .. L=_ }`�' �- <br /> '1J1 '�' � ------------------------------------------------ --- - <br /> ,. <br /> Final Inspection" b Date 10---------- <br /> SAN-:10AQUiN-LOCALHEALTH DISTRICT--------- -• ._ <br /> E. H. 9 .1�i68-Rev. 5M r.. <br />