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rux Vrritz ubt: <br /> APPLICATION FOR SANITATION PERMIT <br /> IComplete In Triplicate) Permit <br /> ._.....................•---.._................... <br /> This Permit Expires 8 Year From Date Issued .....Issued ..d.--....... b <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constrtid and Install the work herein <br /> described. This application is made I compliance with Coun .y Ordinance No. 549 and existing Rules and Regulationst <br /> �� 4 <br /> JOB ADDRE55/LOCAT N ..-.... �• .......................... CENSUS TRACT .......................... <br /> .Owner's Nam !6_14k. :...................6............. ... .... ....! ` ..._.. <br /> .... ane .��. ." <br /> Address :_ ---------------- -- ----------. City <br /> ... <br /> Contractor's Name R&-&... ........................:.............License#R-�15. �-. Phone ......: C .. <br /> Installation will serve, Residence❑Apartment House ComjVerclal❑Traller Court <br /> Motel []Other--- <br /> Number of livinga'nits:.__..._..... 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❑ Clay Joann ❑ <br /> Hardpan❑ Adobe❑ FIN Material ............ If yes,type <br /> ~!Plat plan, showing size of lot,, location of system In relation,to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or'•seepage pit permitted If public sewer is available within 200 feet,) G <br /> PACKAGE:TREATMENT [ } SEPTIC TANK f j Size................................................ Liquid Depth .......................... <br /> Capaclty'-- I............ Type ...........-----.. Material...................... No. Compartments ........................... <br /> --� Distance to nearest_:�Well ....................................Foundation....................... Prop. Line .....................Dd I <br /> .EACHING-LINE [ ) Na:"tof'"Lines......�................ Length of each Line....:....................... Total length 9 # <br /> .-- _ ............ a Filter Material <br /> 'D' Saz gyp ..:.................Depth Filter Material .....:.... ..............................p <br /> Distance to nearest Well ........................ Foundation ........................ Property line ..................... <br /> SEEPAGE PITbe th _.............._.... Diameter <br /> p ................ Number ...................,.........,Rotk Filled Yes ❑ No ❑ <br /> ,r Water Table Depth ................................................Rock Size <br /> ••.. <br /> � ..................... . <br /> Distance to nearestt Well ........................................Foundation Prop. Line ..................... <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ................................. <br /> Septic Tank (Specify Requirements) •.............. ..... ...... ... ......... ,��. .. ;.f. .... ,..,.�.;j'j ...._...............� <br /> I?isnosa Fieia (Specify Requirements) .......o ......_... .�.Q�-Q. :..-- - !'------. <br /> ....... ... ........s ---. ....... <br /> - .. <br /> . ,,: `.. ......................................... <br /> r` (Draw ezi ng and required addition averse side) <br /> —r-hereby certify that I-have prepared-this-"applicoitots and;that -th"ork`will-be-dai =1n' di odart-—with-Scm Joailoln <br /> County Ordinances, Stato'Laws;,and Rules and Regulations of the San Joaquin Local Health Dlstrld. Home owner or licen- <br /> sed agents signature certifiesFtherfollowing: <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 /> :rgned • ........ ... .......: ................................. Owner <br /> By ......... � - Title ............................................... .............. <br /> other than owner). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION,ACCEPTED BY ........ DATE ...... ...... <br /> BUit.DING'PERMIT ISSUED <br /> ............ ......._.........._.........................:._.:.......................................DATE... ................................. <br /> '_ADbITIONAL'CdMMENTS `..°.-.....------•...................................-.•-•-........,............._-...............-.... .......-............-.................... <br /> 1_1 . .. . ... . ... ...•. . . ............................ <br /> �� . ..................................---......................-......... ..._........... ...................... <br /> ...F3 <br /> r > <br /> `Final Inspection' iiy ._ ... .. ...... ...... . ----..--•---........ <br /> p - " ........... = .- --....._....................... ...........Date /� ..�` �_ <br /> EM 13,'2!i , l:.bii lieu. 5a4 SAN JOAQUIN LOCAL HEALTH DISTRICT ` ' 6�7)! 3M <br /> 1 <br />