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APPLICATION FOR SANITATION PERMIT <br />..............................._................ <br />lComplete In Tr[pltcate►Permit No. <br />..t•••• This Permit Expires t Year From Databtved . Date Issued <br />Application is hereby made to the San Joaquin to Health Distri for a permit to construct and install the work herein <br />described. This application Is made I n e with C_ ty OMInonce No. 549 and existing Rules and Regulations: <br />JOB ADDRESS/LOC ON ....'......... ...............CENSUS TRACT <br />Owner's Name._, .. ............................................................... <br />............Phone .............................. <br />Address .....,... 7`...... ......... City .......... <br />'l%Phone �'• 0zIContractor's Name .................: License d. <br />Installation will serve: Res dente p Apartment House t} Commercial ❑Trailer Court ❑ <br />Motel ❑ Other ................................................ <br />Number of living units:...".1..... Number of bedrooms .�.�z.....Garboge Grinder ............ Lot S€Ye.......... ...:...........:............ . <br />Water Supply, Public System and name .4.1-1 ..!-.:r.......,�.��L................................................ Pr#v� ... <br />Character of soil to a depth of 3 feet: Sand ❑. Silt ❑ Cloy C7 Peat ❑ Sandy Loam ❑ Clay Loam [3 <br />Hardpan 0 Adobe 0 Fill Mcterlai ............ if yet, type ............... ............ <br />Onlw�i 1111 � <br />�41M <br />(Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) <br />NEW/ INSTALLATIONi (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br />PACKAGE TREATMENT { 1 SEPTIC TANK[ } Size.... ..?... .. .. ............. Liquid, Depth ..... -.. <br />. Capacity ...[SRR.. Type ... 4�67:z.7... Material ...................... No..Compartrnwts ....�.....:.. <br />Distance. to nearest, Well ....................................Foundation ..�.�1............ Pro Line ..4....:_........ <br />Prop. <br />LEACHING LINE ' <br />{ ] No, of lines .t...�..':..... � ... Total Length ..`..�'t..� <br />......... Length of each line..........`?............ ................ <br />'D' Box ............ Type Filter Material .........:..........Depth Filter Material ......... ................................... <br />Distance to nearest, Well ........................ Foundation ........................ Property Line ........... <br />SEEPAGE PIT (J Depth �k'xq- n.11 Diameter ................ Number ......... ... —.......... .. Rock Filled Yes [g No 0 - <br />Water Table Depth ..........:.....................................Rods Size . ..................... L <br />Distance to nearest, Well .............. ..........................Foundation ......... Prop. Line .................... # <br />REPAIR/ADDITION (Prev, Sanitation Permit # ............. .......:........:........ Date ............................ .} <br />Septic Tank (Specify .Requirements) ...:.................. ...... ...................................................................................._.... <br />Disposal Field (Specify, Requirements) ._....... ..... <br />`� <br />...................................................................I........................ <br />.............................................................................--•---..................._...................................................:........................................ <br />10row 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 Healih.Dlstrict. Heine owner or iitan- <br />sed agents signature certifies the following- <br />" + I <br />ollowing:"t certify that in the performance of the work for which This permit ts issued, I shed! not ernploy any person in such manner <br />as to become subject to Workman's Compe tion laws of California." <br />Signed .......... Owner <br />.. <br />,s ................................................................ <br />By :................. ................. .. .... . Title ....... <br />(if th r th n ow er1 <br />FOR EP TMENT USE ONLY <br />APPLICATION ACCEPTED BY .................. <br />.. . _.�u ........ ......... C----..._..............: ....... .......... <br />BUILDING`PERMIT ISSUED"......'.'-... .................. <br />ADDITIONAL COMMENTS....................................................... <br />................................................. . <br />final Inspection bye ...............�'.._....................... ............................................. <br />............ <br />EH 13 2L 1-611 itev. 5M AN JOAQUIN LOCAL HEALTH DISTRICT <br />DATE..,.,,..�......%...................... <br />.DATE _ ....................................:..... : <br />?. ...r....... <br />............. ..._ <br />Date .......�� .........._...._... <br />8/7h 3M <br />