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FOR OFFICE USE: <br /> P. <br /> APPLICATION FOR SANITATION PERMIT <br /> .. .*......-._. 2:.Q0..py--------------- <br /> P <br /> 1'rNQ Q.00 1oi�l (Compiete'i`n Trip Cate) eimit� i <br />------.................................................. This Permit Expires ] Year From Date Issued <br /> 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, 549 and existing Rules and Regulations: <br /> JOB ADDRESS/IOCATION ...... a ........................CENSUS TRACT ._........._..:...... <br /> Owner's Nome ...............AK!:h!,!--- P!¢tt A•--•-•-••••••-••••--•......••••-•-•••••--•.................:.....................Phone ....?3t ....... <br /> AJAddress 1115'-,91. _. _ .......9A................•----••-•---_. . City .._.1,rb-C_KT4.............. ....... .... # <br /> Contractor's Name "! ..._.License # 1S.-V-_s8M.,.. Phone (�.�. ... ... <br /> Installation will serve: Residence - partment House❑ Commercial ❑Trailer Court 0 1 <br /> Motel ❑Other ........................................... <br /> 1 h c+2�S <br /> Number of living units ...... Number of bedrooms .........Garbage Grinder ._._....... Lot Size ............................................ <br /> Water Supply: Public System and name ................................................................................_............-._-............Private <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ <br /> Hardpan ❑ Adobe fill Material ............ If yes,type ............................ <br /> (Plot plan, showing size of lot, location of .s stem in relation to wells, •- <br /> p 9 y 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 [ j SEPTIC TANK-[ ] Size...,-.....­.­­........................... Liquid Depth _ . . ........ <br /> Capacity -------- -------- Type -••------------•---- Material-------•.............. No. Compartments -_-...._.. .......... I <br /> , <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 /> � y <br /> SEEPAGE-PIT [ ) Depth. ------------------__ Diameter Number ----------_----------_______ Rock Filled Yes ❑ No ] <br /> Water Table Depth ..........................................Rock Size ................................ <br /> �pistance to nearest: Well ........................................Foundation ............... Prop. Line ...................... P <br /> REPAIR/ADDITION{Prey:Sanitation Permit# --.......................................... Date ---------_________.._............. <br /> ) <br /> Septic Tank j5pecify�Requirements) ------- ------�onie9��..............-•--..................................•........................... <br /> Disposal Field (Specify Requirements) ..._. Qi... € �. ..-L� ._I<.._._.___. 3��� 2T' Pi'r <br /> 4 •------•• -----------••........................................... <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 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 /> Signe ------------ ---------------- Owner <br /> ES l. <br /> BY .--•- a------ ---------------.......... -•-• _.. Title .....------......_ ...... <br /> (I other th n owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. .... .. <br /> .. ....... •-•- -•--•••-•---•..............................•.................... DATE .... .. .... <br /> BUILDING PERMIT ISSUE[;ti ---- ------ ------- -.------- ------- DATE � <br /> ADDITIONALCOM T .. .. . .. .. . . - ........................................................ ........................... <br /> d _/ ..._. ...., .. . ........ ............................:........................................•-•----•--••. ............................... <br /> Final Inspection b • .............. .. ............ <br /> ......... •--......:...-----•••-•-•..._.._.._. <br /> p ...- Y ..... _...._,.. .._ ��SA <br /> N.JOAQUIN L CAL_HEALTH DISTRICT <br /> Date . .r..,Z --- <br /> T E <br />