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FOR OFFICE USE: dwo` <br />... <br />APPLICATION FOR SANITATION PERMIT <br />.._... ...... ._....... .. r"`�,. Permit No..............__... <br />(Complete in Triplicate) <br />.... �__This Permit Expires 1 Year Prom Date Issued Date Issued ......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 compliancjjee� with County Ordinance No. 549 and existing Rules and tRegulations: <br />.LOB ADDRESS/LOCATION .�.�. ..-...tt.. �. .45tZ�,Z_ ._CENSUS TRACT <br />Owner's Name -....... ,,� _ .. .Phone... ..-W".., <br />Ic <br />Address _ ..__ _ ....g...',............._ . Contractor's Name _ _ _ __.............................................::._.... License # Phone ........_....._....... <br />Installation, will serve: Residence X Apartment House 0 Commercial oTrailer Court a� <br />Motel ❑ Other _........._....................._.,..._. <br />Number of living units:.. .... Number of bedrooms ,I.' -..-.Garbage Grinder Lot Size( .. . 6.6_o......•...... <br />Water Supply: Public System and name ._._. ................................,......._...... Private j z, <br />Character of soil to a depth of 3 feet: Sand (• Slit n Clay ❑ Peat 0 Sandy Loam Q Clay Loam,, <br />Hardpan ❑ Adobe T Fill Material 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.) <br />NEW INSTALLATION: (No septic tank or seepage pit permittee) if public sewer is available within 200 feet,) <br />PACKAGE TREATMENT (j SEPTIC TANK l� '� Size_ ......- %�......... Liquid Depth ...... �.. �1 <br />Capacity ../ <.c;J e �!". .1 - MaterialCompartments �........ <br />Distance to nearest: Well .... .!;�.. ...............Foundation . d. ........_. Prop. Line... .......... <br />LEACHING LINE [ No, of Lines ...-...... _ Length of each line.... -..6...... Total length .... �.�/ <br />..Uepttht fniter Material ......._' .� l ........ ................ <br />'D' Box ...i,,•-'�. Type Filter JN teria(�.............. p <br />Distance to nearest: Well ..... . .... fnca tion -.I........ Property Line .%.. ._......... <br />SEEPAGE PIT Depth - 1.- Diameter .mber ..._. Rckl>� Yes j No <br />Water Table Depth .. _ ..._......................... ..Rock Size..--�' _..--- <br />Distance to nearest: Well ....,r.._---....__ ..Foundation .. d.....-.. Prop. Lina __.~__...._. <br />REPAIVADDITION (Prev. Sanitation Permit #............................................ Date ..................... <br />Septic Tank (Specify Requirements) ----------- ............... r_._... ... ............ ...------ .,--------- _------------- ...,..-------- ------------------ <br />Disposal Field (Specify Requirements) ._....... .W. v .......................... ..w. .......... ­- _._-._....... ....._.. ................ <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 Sari Joaquin Local Health District. Home owner or licen- <br />sed agents signature certifies the following: <br />"I certify that in t performance of the work for which this permit is issued, I shall not employ any person in such manner <br />as to Dec m sub to Workman' Com enstation haws of California." <br />Signed .�L/ ... . .......................... towner <br />By...... ..................................... ......_..._. .__._....._..._._._. _... . Title ..._...____ .".,..... ......_.., _.. __................ <br />(if other than owner) _. <br />FOR DEPARTMENT <br />ONLY <br />APPLICATION ACCEPTED BY .�_ .4.-C. ..... DATE .l'"'.?." 1....... <br />.. . <br />BUILDING PERMIT ISSUED . ...................................................... .. _..................DATE ............. <br />ADDITIONALCOMMENTS .. .................................:...__.... ____ ....... ..._,_..y..._...._.... __...... .....,....................... <br />............... ............... ........................... ............. ............ ............. _...... <br />Final inspection by: .......Date ........ ,i.__ ................. <br />SAN JOAQUIN LOCAL HEALTH DISTRICT'} <br />E. H. 9 1-'b8 Rev, SM <br />