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FOR OFFICE USE: <br /> APPLICATI6N FOR SANITATION PERMIT p <br /> .** -,% Permit No. ..7 -�• �•- <br /> ................................................ (Complete in Triplicate) <br /> .......................• Date Issued <br /> I 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations <br /> JOB ADDRESS/LOCATION F,. _ --..--.-.- - <br /> ----. - ........CENSUS TRACT ....... <br /> ®-. .' 1- �.._.. ---Phone . .. ... .. . - <br /> Owner's Name -- .. 1_d.:..._ Q.._.L' _.. i <br /> _..maw.................� <br /> Address ....�_ �5 ...,. .- _'-. �•+� ��r <br /> Contractor's Name <br /> :♦Pl. Q ...License # ,7f?... Phone , �'�7. ?-•-• <br /> Installation will serve:" ResidencgXApartment House-n Commercial ❑Trailer Court [] <br /> Motel C]Other --------------- --------- -------------- ---- <br /> � Number of living units:_...- Number of bedrooms <br /> I4*.--.--Garbage Grinder _.._...._.- Lot Size .. .................. .. •--••--------• <br /> Water Supply: Public System and name ..................... .....-_.- ---------- ........... ....................--.......--•.Private <br /> Character of sail to a depth of 3_feet:• Sand5ilt❑ , fay„.❑;, Peat_[j. Sandy Loa mX�..Clay.Loam_C1U <br /> Hardpan ❑ AdobeK Fill Material ......___. If yes, type ------- -------------------- <br /> k (Plot pian,, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> 4 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> ! '' <br /> PACKAGE TREATMENT E ] SEPTIC TANK-T.} Size.,----------------............................. Liquid Depth ........... .----:........ <br /> Capacity 1 <br /> _ -- - - Type ---•.........:..... Material... _ <br /> ..._..... ....... No. Com .. <br /> Compartments ---•---._. :.----... <br /> Distancetto nearest� : Well . .....•..-- -..----------- ........_Foundation -.--------...---.. Prop. Line'_.._.__...,..._....__LEACHING LINE No. of Lines ... -. - Length of each line. ...................._.... Total Lengt� 1�.-..•---..__.. <br /> 'D' Box` _.' Type Filter Materiah....a_._r� ----Depth Filter Material _.._..:,�...--.- ---- ------ <br /> Distance to nearest: <br /> Well ..f._ C ._.?�-J-... foundation ...... ........... Property line . . _..: -•••• <br /> SEEPAGE PIT Depth . '�.. ----- Diameter I c _- Number., ,.-.-. Rock Filled Yes ' No <br /> Water Table Depth . ----------_--------- --••-----•--------•-----Rock Size .... .......... -•--•-- ------- <br /> i Foundation - Prop. Line ----_----•— -•---- <br /> Distance,to nearest: Well .................... . <br /> REPAIR/ADDITION(Prev. Sanitation Permit# - ----------- - ---- Date --,•-----....---...----• <br /> - 1 <br /> f Septic Tank (Specify Requirements) ..._... --------- •----- <br /> Disposal Field (Specify Requirements) ------------ -- •--•-- - <br /> ... ..................................... <br /> {Draw existing and required addition on reverse side) <br /> L <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 (icen- <br /> I 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 bec su jec to orkm Compensate n law. f Califorinia.'” <br /> 1-2 <br /> ��7 <br /> Signed .. <br /> :p Q7wner -"" <br /> r Q�.g . Sitie .�►s.L..�... <br /> f of er than owner) "++ <br /> t ; FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . .. / .•+,*,..-^-• -- .............DATE .-...... --- ..__.....�........ <br /> BUILDING PERMIT ISSUED __.. --t -------- ---- - - DATE . . .... ---- <br /> ADDITIONAL COMMENTS ...._+1--• ---- --....................... . _....I——._•-- --•------- ------ <br /> + ---- ­---......I . ...... .... ............---------..... ...................... <br /> ---------------- ---------- ----------_ ......f ....... ­-------------------- _--_........._..._......... <br /> _ .. ... <br /> ------ ---- ----- <br /> Final Inspection b __ . ...._....._ Date ......... ......y: -•-.._..._/!,' .: ...... e . <br /> SAN JOAW-IN LOCAL HEALTH DISTRICT <br /> •tea o_.. u• � - - <br />