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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> ----•----- -•--- -7<-- <br /> Permit No. ............ ------ <br /> --i------ -------- I i <br /> (Complete in Triplicate) <br /> Doti Issued .................... <br /> .........................................11.............. This Permit Expires 1 Year From Oat*Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a per construct'mit to constr� 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/LOCAT'19 70 ...... .......I.......,CENSUS TRACT .......................... <br /> Owner's Name ' I- . . ... .. / ............... !.4 <br /> .......Phone ................ <br /> Address ._ �...... city ...C <br /> .................... ............. <br /> Contractor's Name .. ....�­_­. ­ ..... .........%.... .......License ...................... <br /> Installation will serve: Residence Apartment House f] Commercial oTraller Court C] <br /> Motel_Q Other ..... ...................................... <br /> it L <br /> Number of living units:-..,(__." N-Uml5-ee-df-6-e-dFddms -.Garbage Grinder ............ Lot Size <br /> Water Supply: Public System and name -7 .................. ..........**­-----­---- -........-.................... ...........Private <br /> Character of soil to a depth of 3 feet- Sand 0 -Silt 0 ' ,Clay E] Peat 0 Sandy Loom ay Loom E] QN <br /> Hardpan E] Adobe-o' .•Fill,M6terlal ...... if yes,type............... ........... <br /> �n :' system in relation wells, buildings, etc. must be placed on reverse side.) <br /> (Plot plan, showing size of tot, locoti of 10 <br /> J <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f I ..'SEPTIC-TANK;) Size................................................ Liquid Depth .......................... <br /> Capacity -------------------- Type ----------------e"-`/ Material...................... No. Compartments .......... .............. <br /> Distance to nearest. Well ------------------------------------Foundation -------_------------- Prop. Line ...................... <br /> LEACHING LINE No. of Lines ------------------------ Length of each line.--- ----------------- Total Length ............................ <br /> 'D' Box ------------ Type Filter M;ieribl ... ................Depth Filter Material ............................................ <br /> I. Distance to nearest. Well --------_------­1... Foundation ......................... Property Line .....................�S <br /> No. <br /> SEEPAGE PIT Depth -------------------- Diameter .............. Number ............... ............ Rock Filled Yes [I <br /> I <br /> Water Table Depth ................. ...-----......Rock Size ...................... ...... <br /> Distance-to-nearest:.-Well .....................................i­_.-Foundation. .............. ..... Prop. Line....----.............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------- ---------- ----- Date ---------------------------------- <br /> ..................... ....... ......... <br /> Septic Tank (Specify Requirements) ....... ............ ----------- .. .. .............. <br /> Disposal Id (SpeSqy'Requor�'me_ ------- <br /> ------&z�..... <br /> :7:.............. <br /> -•------•- <br /> -------*--------------------------------- ------------------------------------------- ---------------------------------­----------- .......... .............................. ............... <br /> (Drow 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 Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or llcon- <br /> sed agents signature certifies the following- <br /> "Icertify that in the performance of the work far which this permit is issued, I shall not employ any person In such manner <br /> as to become subject to Way 's Compensatiqn-4aws of California." <br /> Signed .............................. ..... Owner <br /> By ----- •---------- --- --------- -- Yitle --- .................. <br /> - -- ----- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- ........ ----------------------------------------------- ................. DATE _7 ....... <br /> BUILDING PERMIT ISSUED .................•--_... ----------- ---------­---DATE ...._.--------------------- . : .. ._. <br /> COMMENTS ............ ...................•-----...........--.................------. ..........­­...........­­ ----------­......... ...... ....... <br /> .-•-------------- -------------•-------•------•-•--•-------------•----------------------.- ... <br /> ............. ---------------------------------------I----------------------------------------------------- --•----------- ---------------------------------- .... -...-; - <br /> ------------ A ... ----- -------------- <br /> ---------------- -------------------------- ...... -----------•-----------------------------­­­...... /- . --- ------- <br /> --------------------- Date <br /> Final Inspection by: ----------------------------C.,%A--------•----•----•-••-•----•------•-••--....--..... .................... <br /> EH 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />