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FOR OFFICE USE: 1 <br /> APPLICATION FOR SANITATION PERMIT 6� PermitNo: <br /> 7 <br /> --- ----------------- ----------------------------------- <br /> (Complete in Triplicate) <br /> -------------------------------------------------- <br /> Date Issued _���--_______. , <br /> --------------------------------------------------------- <br /> This Permit Expires 1 Year From Date Issued <br /> f <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 application is d in ompliance with County Orclinanqp No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION --- <br /> ff CD_ "' --------CENSUS TRACT ___S14 -------• ----- <br /> 01 <br /> Owner's Name --- - Phone <br /> Address <br /> S ---- - ---- ---- -- - - ------------------------------------- <br /> -- r <br /> - �� --- ---- ----- Y <br /> J N�--�� - -'---.License �6 _y Phone ------------------------ <br /> Contractor's Name ----� --'Lt-�-�.J----- -- - - -----------� -- - <br /> Installation will serve: Residence partment House❑ Commercial ❑Trailer Court i❑ 9 S� <br /> Motel ❑ Other ------------------------------------•------- <br /> Number of living units:------I---- Number of bedrooms -3-----Garbage Grinder ____________ Lot Size ----- - <br /> ,q <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 Loam DO <br /> Hardpan ❑ Adobe ❑ Fill Material - ________ if yes, type ____---____________________ <br /> (PI"ot 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,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size_________! __�_b____-_x__'�--- -__ Liquid Depth -.----�--------.----- <br /> a f <br /> I CapacityQ.. ---- Type -------------------- Material__ No. Compartments --------•---.. <br /> t., w Distance to nearest: Well -----------.15Q------------------Foundation ------- Prop. Line ___.- ..--- ----- <br /> LEACHING LINE No. of Lines _-__._-� -------- Length of each line.-----f c)_b------------ Total Length -_ ----------- <br /> [ <br /> t ______,�_ er <br /> 'D' Box .____ -_-__ Type Filter Material � �_e____Depth Filter Material �;_____________________________ <br /> € Distance t nearest: Well ------_, +�__ ____- Foundation ------1_t7--l____-_ Property Line --- ----------------- <br /> i rr <br /> -__ Number -____-----c -.---------- Rock FAA Yes [ ' No i❑ <br /> SEEPAGE PIT [ Depth _.__�---- ---- Diameter _ __ _ �� <br /> t it <br /> Wafer Table Depth -- <br /> ------------��-`�--------------------Rock Size ------ ----x-'� -•--- �, <br /> Distance to nearest: Well ______________ _.f____-.___.-Foundation ___-_��'a--�---- Prop. Line _�A_________________ <br /> I <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- -- Date _______-_______---------_--------- ---------------------------) <br /> Septic Tank (Specify Requirements) ---- -------------- --------------------------------------------- - <br /> Disposal iField (Specify Requirements) ------------- ••• <br /> -------------- --------- = " <br /> --` ------------------- r-------Y <br /> i <br /> _ __________________________________________________________________________________________ <br /> _ _______________________________________________________I--______-______...-___ <br /> ---------Y____'------------------ -----------------------------------------------------___---__-____________-__-_________-________--____________.__-_-----_._________1__.---__-_-___-____.--___ <br /> (Draw existing and required addition.on reverse side) f <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. Nome 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 Work n Compensation laws of California." rt <br /> Signed ----------_-------- - Owner <br /> BY - - ----------------------- - t Title <br /> L. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br />' APPLICATION ACCEPTED BY - --------------------------------------------------------- BATE <br /> BUILDING-PERMIT ISSUED -------------------------------------------------- -------DATE ------------------------- ------ <br /> ADDITIONAL COMMENTS ------------------------------------------------------------------ ------------ <br /> ---------- -------- -------------------------------------------------- <br /> - <br /> w, _ __________________________ <br /> -______________________________________________________________________________________________________________________________________________________________________________ _ <br /> ____.___-_._________________________ ____________ <br /> ___ ___________ ___ ------------ <br /> . __ <br /> ________________________________ _ _ ___ <br /> Final Inspection by: -- Date -/ j <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r-1W v i-'AR RPv 5M <br />