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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> \. (Complete in Triplicate) <br /> Permit No. __.7.. _ --------- <br /> �- Date Issued <br /> ------------------------------------------ This Permit Expires 1 Year From 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 applrcation is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADIJFESS�I.LOCATION ----------_--- -------------------- 1 � t` CENSUS TRACT <br /> Owner's Dame _ � s ___-__ <br /> ' � --- --,h- -------- --Phone ------------------------------------ <br /> Address ' f -�' - -- ............ f CityI _ .t- <br /> , - - <br /> . "� <br /> Contractor`s Name -- '` n ' ---------------_----------- <br /> -----------------/------ -- License # Phone <br /> Installatiogn will serve: (Residence-❑ Apd.�tment House CommercialTrailer Court`; <br /> 1 f Nloel F-1 Other <br /> -------------------------------------------- <br /> Number of living units:__"-,__ Numbe/of bedrooms -.- ------Garbage Grinder Lot Size -rz- L 'C� ------------------ <br /> Water Su; ply; Public Systemiand name ---------- --------------------= ----------------------- ----­---------------- -------------------Private <br /> Characte?rof soil to a depth of 3 feet. Sand Silt❑ Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑ <br /> 1 Hprc7pan ❑ Adobe ❑ Fill Material -___---_-- If yes,type ----------------------------- <br /> (Plot <br /> ___.___ -__-__-_____.-_(Plot plan,-showing size of lofi, 'Iota.tion, of �, stem in relation to wells, buildings, etc. must be` placed on reverse side.) <br /> NEW INSTALLATION: <br /> (�fo septic tdnk or seepage pit p2�rmitted if Qublic sewer is available within 2C, feet,) <br /> PACKAGE/TREATMENT [) SEPTIC TANK;N Size_,�j_'.___.9�_► --------------- '� <br /> •� --------------- --- Liquid �.�pth --��----------------- <br /> 71. <br /> u / s <br /> TypMaterial Z-,f W------ No. Compartments <br /> Distance t, o. nearest: Well _ L -----------------------Foundation _,W------------- PropLine _--___-__..__ <br /> - LEACHI 'G LINE No. of Ones ____-/------------------- Length of each line_ <br /> 9 - - Total Length ==L <br /> D' Box-` <br /> �e_ Type Filter'Material _-_1k_�______Depth Filter Material __ __ -- ----------------------------- <br /> 4 <br /> SEEPAGE PIT D /12 / <br /> e �� , _____-.-_ Foundation _.._ Property Liri <br /> o�� .____ . e _ ----------- <br /> ._ l� __ <br /> Distance to nearest: Well _' <br /> / ter'�_l�.__..______ Number -----/111 Rock Filled es�' No <br /> � � E .. <br /> 'Nate.r; F'abl'e Depth <br /> . . Rock Size �__ . -_--------- --- -- <br /> Distdnce to nearest: Well I . -- ___ -Foundation e.. ��e . Prop. Line ------- <br /> S <br /> ,.. <br /> REPAIR'/ADDITION(Prev. Sanitation Permit# ------ --- Date ---------------------------------- <br /> r <br /> Septic Tank (Specify Requirements) --_---------------= A--- ------------------------------------------- <br /> } Disposal' Field- (SDecify,­'Requireme T§ ------ r--- - --------- ------ ----- -- ---------- - ------- ----- -------- ------ -------- --- ---- <br /> • <br /> l _ir.__t4 ____.____. -_, __--_____. _ ______-_____________-_-_-_-_._-.____-____________________________-__.______-_.-------___.-__-____.-________ <br /> --- ------ ------------A--------- -------._-----------------------.------------------------ <br /> ---- ----------------------------------------------------------------------------- <br /> 4 (Draw existing and required addition on reverse side) <br /> I here ,�.certify that I have preparAM this application and that the work will be done in accordance with San Joaquin <br /> y <br /> County`6rdinances, State Laws,and Rules and Regulations of the San Joaquin local Health District. Home owner or licen- <br /> d agents signature certifies the following: <br /> "L certify that in the performance of the work for whi h,this permit,is issued,`ishall not employ'any person in such manner <br /> as to become subject to Workman's Compensation law s`of,.California.7, ``• ''' t <br /> Signed --.rte --- - -- ------------------------------------------=-- Owner'• <br /> BY - ---------- <br /> it iTle; G -- - <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------------------------------------------------------------------------------------------------. DATE <br /> �J BUILDING PERMIT ISSUED ---------------------------------------------------------- -----------------------------------------------DATE ------------------------------------------- <br /> JADDITIONAL COMMENTS ------------------------------------- -------------------------------------------------- ------- --------------------- --------- ---------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - <br /> ---------------------------------------------------------------------------------------------------------------------- --------------------------_------------------------------------------------- <br /> ------------------------------------------------------ --------------------------------- ---------------- = ---- <br /> Final Inspection by: --------------- ----------------------- ---------------------------------------- . Date ------ �--r�--�-------------------- <br /> ----- -- --- ----------- _ <br /> - - <br /> --- --------- ---- <br /> SAN JOAQUIN.LOCAL HEA`L-Tfi DISTRICT <br />