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FOR OFFICE USE: -APPLICATION FOR SANITATION PERMIT . ! <br /> ��---'70 <br /> -- -------------- Permit No. ---------------------- <br /> (Complete <br /> ------ ----- -------.(Complete in Triplicate) <br /> = - ---------- --------------------------- <br /> Date Isoued Al-ia-(;V <br /> -_ ---. This Permit Expires I Year From Date Issued <br /> _ -2.C)Lf--a-7a--may <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described, This application,ris made in compliance with County Ordinance No. 549 and existingrR-ulers"n Regulations: <br /> 23`!oPf <br /> TRACT <br /> JOB ADDRESS/LOCATION ----- -- -- ------ ----------------------- <br /> --- ��r --- — <br /> -- -----•-------- <br /> Owner's Name - ----- - - --- --------- -- - ----------------- ------- <br /> ----Phone -----------------------;------------ <br /> -----S ------ Cit ---------- <br /> Contractor's Name _t -------.License # .aS-� - Phone <br /> Installation will serve: Residence ❑Apartment House�❑ Commercial ❑Trailer Gauctr <br /> Motel ❑ Other .------------------------------------------- '- <br /> Number of living units:----- __. Number of bedrooms --�--Garba_ge Grinder ____ _ Lot Size -------------------------------------------- <br /> Water Supply: Public System and name ------------------------------ --•--- -----------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'k Silt I] Clay ❑ Peat ❑ Sandy Loam -❑ Clay Loam ❑ <br /> ' Hardpan ❑ Adobe ❑ Fill Material _Nf?___, 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,) W <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-- --------------- Liquid Depth ----- ------------------- o <br /> r >� TyPe gip_--_-- . tenal- �— No. Compartments <br /> -Capacity <br /> my <br /> Distance to nearest: Well -------,f�+ __�--------------Foundation --- � ------ -- Prop. Line "'L-- <br />,: [ l �r-- ------------------ Length of each line_-__-- --- - -------- Total Len th` ,--- 14W------------- <br /> ------------- , <br /> y Filter Material ---- -- - - -------------- <br /> LEACHING-LINE No. of Lines -9 g -•------- ------- <br /> 'D Box .,��_____ Type Filter M$$atena! _Ag--- .l� � <br />` Distance to nearest: Well _-- !------- Foundation .�----_----____ Property Line ---------_-----__-.:---_ <br /> SEEPAGE PIT [ J Depth --------------------- Diameter ---------------- Number -.______-----.------------- Rock Filled Yes C] No ID <br /> WaterTable Depth ------------------------------------------------Rock Size _.-------------------------- <br /> Distance to nearest: Well --------------------------------------.-Foundation -------------------- Prop. Line ---------------------- <br /> t <br /> �REPAIRfADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -_-----__----------_-_---_--_-_---) <br /> Septic Tank (Specify Requirements) T --------------------------------- ---------------------------------------------- <br /> DisposalField (Specify Requirements) -------------------•--------•------------------------------------------ -- ---------------------------------------------------------- <br /> ------------------------------------------------------ <br /> ---------- ?---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------ - -------- ------------------ --- ---------------------------------------------------: ------------------- <br /> ------------ <br /> I (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." 4 <br /> i Signed --------------------------------------- Owner <br /> ------------- ---- ---- <br /> BY ��'� ----- <br /> Title ---- -----�---- - - - ---------- <br /> i. [!f other than owns Y <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------TAR ------------------------------------------ -------- ----------- DATE <br /> BUILDINGPERMIT ISSUED ---------------------------------------------------------------- --------- ---------------- -- ---- ----DATE ------------------------------------------- <br /> AbDITIONALCOMMENTS -- - ----------------------------------------------- ---- --------------------------------------------------------- --------------------------- <br /> --------------- <br /> ............... ... <br /> ---- - ---- ---------- ---------------------------------------------------------------------------------- - ------------ <br /> -- --- - -- ------- ------------------------------------- ------------------- ------- ----- ------- <br /> -------------- ------ f <br /> Final Ins a � ----------------•---------- Date !- " <br /> P <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br /> # E. H. 9 1-'68 Rev. 5M <br />