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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit.-No. _-7a-.4- ---------I---------------------------------------------- <br /> (Complete in Triplicate) <br />� <br /> ---�---------------------------------------------- <br />°:- Date Issued <br /> This Permit Expires ] Year From bate 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 <br /> #Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION '%+ -.�-- "�"�Y.*— �`�------ .-, � ENSUS TRACT -�_�-b---•----------- <br /> Owner's Name -- ------- ---- <br /> ---Phone -----------------------_- --------- <br /> Owner's .------ - '�------------------------------------------------------------- ----_-,-�-tom. <br /> - - - - J �-�-�------------------------- -.. City,. ✓�"� _ <br /> - ------------------------ <br /> Address <br /> - -�f-�-------- <br /> Contractor's Name4 r*--------- ---� ------License # ------------------------ Phone���. <br /> Installation will serve: Residence]Apartment House❑ Commercial:❑Trailer Court i❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:____------- Number of bedrooms ---�)......Garbage Grinder ------------ Lot Size 4- -------------------•- <br /> Water Supply: Public System and name -------------------------------------------- •----------------------------------------------------••-•-------Private. <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ; <br /> Hardpan,2 Adobe '❑ Fill Material _-A------- 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:) i%, ' <br /> NEW INSTALLATION: (No ermu <br /> i <br /> it seepage se tic tank orpermitted if public sewer is available within 200 feet,) J,� <br /> pp p - <br /> PACKAGE TREATMENT [ SEPTIC TANK j�!] Size -------- -------- -- --------- - Liquid Depth _-_-._---_-.-------,___-- N <br /> Capacity _/4-i -------- Type nts _- --------------- N i <br /> Distance to nearest: Well �____--_--_._ Foundation _-_ _-_--_____..pProp. <br /> - _��_ Material--6c' -------- No. Compartments <br /> - ---- --- -- Line ._-9?"D----------- <br /> LEACHING LINE [ No. of Lines -_._�--------------- Length of each line------/074)___-_------ Total Length --- <br /> 'D' Box --- Type Filter Material fr -------------Depth Filter Material _1 ---_-__--- ----------------- <br /> Distance to nearest: Well ___f0 _____--_--_ Foundation __ �-�_----------- Property Line- --------- _----------- <br /> i SEEPAGE PIT [ ] Depth - --- ----- Diameter 1.9--------- Number ------or ----------=---=-`z Rock Filled Yes, } No 0 <br /> I. <br /> Water Table Depth --- Rack Size _ -- ---------------------- <br /> Distance to nearest: Well ---4�__---_--f----- ---------------Foundation ,1 .� ------ Prop. Line _- ----------- <br /> r <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------------- ---1 <br /> l Septic Tank (Specify Requirements) ------------ --------------------------- ------------ -------------------------------------------- <br /> Disposal Field (Specify Requirements) -------------------------- -------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------ --------------------------------------------------------------------------------------------------------- <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 /> 4` 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 tha 'n the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to beco# Yubject tSi Workm .a s Compensation laws of California." <br /> Signed <br /> Com~ ------- Owner <br /> BY Title ------------------------ ----------------------------------------------- <br /> - ------------------ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - --------------------------------------------------- DATE ' :' --------------------- <br /> ---- ----------- <br /> BUILDING PERMIT ISSUED ---------------------- ---------------------------------- <br /> --------- ----------------------- -- ---------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ----------------------- -------------- --------------------------------------------------- --------------------------- <br /> ------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> i ----------------------------------------------------f-------------------------------------- ------------------- -------------------- ------------------------------------------------------i <br /> -- -•- <br /> -- ---------- ------ <br /> ------------------------ ----- ------------- ------------- = ------ <br /> -------.Date /- -- -- ---- -- - <br /> Final Inspection bY� - -�"st..G!�,�- ---------------- --------------------------------- ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t <br /> t a, E.H,9 1-'68 Rev. 5M. <br />