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FOR OFFICE USE: <br /> `. � =� APPI~iCATl01�1 FOR SANITATION PERMIT <br /> �.... Permit No. <br /> .................... ... �i�-.1 .. <br /> . <br /> (Complete in Triplicate) <br /> :.? <br /> .-...... This Permit Expires 1 Year From Date Issued 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 /> tt(D.3 -±�Nrr��n, o ......................CENSUS TRACT ........._._._:......:.... <br /> JOB ADDRESS/LOCATION ..t.... <br /> ...Phone ... 6 <br /> Owner's Name .. .. ... . ... a 8 fib; 4 <br /> ...........:] vch F.- E►2?arr .!� <br /> Address ........... ------ .. City . ,c ►"n'.............................. ..................... <br /> R t vis 2ND-: License # a5 -3 - ..._ Phone . .- �?`�.7... <br /> Contractors Name ---------�..-Y.....- -.? .... .. <br /> Installation will serve: Residence lApartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other -------- ---------------- --------------- <br /> l ,3.__.--.Garbage Grinder ............ Lot Size ....-r- -... �'.... <br /> Number of living units............. Number of bedrooms . <br /> Water Supply: Public System and name ....................................-..-.-----------------------------......- ..................................Private [ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy loam fl Clay Loam j <br /> Hardpan ❑ Adobe [ 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 permitted if public sewer is available within 200 feet,) <br /> N { p <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size................................................ Liquid Depth ...................... <br /> Capacity ....... Material---------------------- No. Compartments <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of eachline-.-------------------------- Total Length --------.--............... <br /> D' Box Type Filter Material ...Depth Filter Materia! <br /> Distance to nearest: Well ------------------------ Foundation ........................ Property Line ...................... <br /> I <br /> SEEPAGE PIT [ ) Depth .................... Diameter ................ Number ---------------------------- Rock Filled Yes ❑ No Q <br /> WaterTable Depth -------••--------- -----------------------------Rock Size ................................ <br /> Distance to nearest: Well .....................Foundation ................ Prop. Line ......._............... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ....ls -'-$ ------•---- Date .........) <br /> Septic Tank (Specify Requirements) ------- ................................................ .....................r .......----•------.....-...---........,_......__...__••: <br /> Disposal Field (Specify Requirements) .--•---------- ------------------------••......--..... ....... .............. <br /> ZA8i` ."x..1a:.:.- -- .. 2-------------------------- ._........ . • ....... <br /> ---------------------------------------------------------------------------------- ------------••-----•----._....------......--- <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 /> 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 /> 1 Signed ... -------- .......•-•............----------------- <br /> Owne <br />' BY ...... . y......................................... Yitle - <br /> {If other than owner <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... ` 4._ DATE -�.........._.,_. <br /> ex- . -----------•. <br /> + BUILDING PERMIT ISSUED ................��..--------.......... ..... DATE ... ;... <br /> ADDITIONALCOMMENTS ................=•...............................................---•.-..............------• .................................................I.............. <br /> ..._.....__�• Z' -------------•----------......_ •--------••.._......_..._•--•----__•------..--......----.-..... <br /> ..- •------ -•-- ..... .. .......---. _.. z. ....... <br /> ( Fina! Inspection by: Dale <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7172 3 X <br />