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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ••• � <br /> Permit No <br /> (Complete In Triplicate) <br /> _ <br /> ................................ <br /> ,. *, , ; .Dote Issued <br /> ............... `'This Permit Expires 1 Year.Froin-Date Issued `- <br /> Application is hereby mode to the San Joaquin Local Health District fora permit to construct and install the work herein s. <br /> described. This application is madeiin compl16hce:with,County Ordinance No. 549yonexisting Rules and Regulations:JOB ADDRESS/LOCAT ON .... .�.._ a. ........6,.,,....rll..��/'. .ir/......, a, (� �.....CEN5U5 TRACT <br /> Owner's Name ...ect .' �!.�?. f -. -1. :C-t ` .....:.......:................................... `...:_.: :Phone <br /> Address 7;;. 4 ......... .`---.........I...---...... City . ....... ............. ............. ..... <br /> :.. <br /> �- <br /> Contractor's Name ..... _ .. _ r! '� ---- . ........ ...,L:tense 5# r � Phone k �. . f... <br /> Installation will server - Residence Apartment House Commercial [IV611er,Court <br /> Motel 0 Other ....................................... <br /> L <br /> Number of living-units:... ._.:... Number of bedrooms .......Garbage Grinder... Lot Size ......:............. <br /> ar i <br /> Water Supply, public System and name ...:................................ ....................................................Private <br /> Character of soil to a depth of 3 feet: Sand b. ,Silt Q '-Clay„0 Peat D.__Sandy Loam C] Clay Loam]. � <br /> i•lard <br /> p` <br /> .. -�. dobe 0FI}I Material ............ if yes,type ............................. <br /> , <br /> ,an. <br /> i❑ A d • <br /> (Plot plan,-showing size of lot, location of;system in relation ,to—wells,—buildings,,etcf r lust be placed on reverse aide.) . <br /> NEW INSTALLATION: (No septic.tonk or,seepage pit permitted If public,-sewer is available within 200 feet,[. <br /> PACKAGE TREATMENT .[ I ., SEPTIC TANK t ] Size.].......:. ..:................................ Liquid Depth .............r............,J <br /> Capacity .. ................ Type Material. .. ... No. Compartments ........................ 0 <br /> Distonce-to�-ni�bresh Well :.:`.,bundation . .............. Prop. Line . <br /> LEACHING LINE [ 3 No. of Lines ... ._ . Len th of each line...........i.... :. ....: Total length ..-.--• ... <br /> ................. <br /> 'D' Box .....':... T ter Mat ial -......Depth�Rilter WOW ......................................' ...... � <br /> .... . <br /> Distance to nearest: Well ......... atlOn a -......... . ...... .Property Line ............. .......... <br /> SEEPAGE PIT [ j Depth ......."..--. Diameter .............._,Number ...s.................... Rock Filled.. Yes d No 0 <br /> # ]r <br /> k Water Table Depth .........:....... :`........Rock Size ..... ....................... <br /> Distance to nearest: Well ........ ..........................Foundation ............ Prop. Line .........,. r <br /> . <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ................. ......... �. Date ............. ..................1 <br /> Septic Tank (Specify Requirements) <br /> w. Disposal 'Field (Specify Requirementsl, ..... ........ /'� ---.•--•-• .• <br /> ................. --..... <br /> ......-•...:..:.......................................... .:........................._:-..-----------_-......-----......-----...... . ......................----- : .:... ................ <br /> (Draw existing and required addition on reverse side) w1 _: <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Jdaquln <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health-District. Home:owner r licen. <br /> sed agents signature certifies the following: - �q <br /> 4 "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 /> f' as to become'sub[ect to Workman's Compensation laws of California." <br /> Signed .......... ......-- Owner, t r <br /> By .:-.. e„ ' ---------- ' .........:...':_...........}... 'jitle . �' --:.. j s <br /> other than owned <br />` ! FOR DEPARTMENT USE,,ONLY <br /> APPLICATION ACCEPTED. BY ............ <br /> _BATE= • -••---•-- ��~ <br /> D ' <br /> BUILDING PERMIT ISSUED w .._....___..—.......... i .................DATE <br /> ADDITIONAL COMMENTS .... ................................... <br /> -- _ .. ......................................•-------......_...............:.......... <br /> ...................................... ..... ..................:. . ..............------ ° -•---••--------..............._.........................._.. .. <br /> -- --�-----•...................................... ....... .�.'7 <br /> t Final InspectiJon bY. --- . ......__.. .................................Date .... f-. ........ <br /> SAN JOAQUIN LOCAL' HEALTH DISTRICT <br />