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y N <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. . s... S <br />....................................••-----..... I....... _ <br /> This Permit Expires ] Year From pate Issued 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 .... .g�� _,.....Sa......�P/ '1.N.L. /.... 1�.r.-.........CENSUS TRACT ................. <br /> Owner's Name ...................... C.✓ s .z <br /> Address ............ / 47`.............................. ..•--.... ............................ City o................................................. <br /> Contractor's Name _.../1 .__ ;;W7,7 ._.;WY _-2-IO License..License # r71;R';K2... Phone <br /> Installation will serve: Residence 1�0 Apartment House 0 Commercial ❑Trailer Court 0 <br /> / Motel ❑Other .........................------............. <br /> Number of living units __.-!.: .__..- Number of bedrooms ....L.-Garbage Grinder IV. lot Size ... ............... <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 ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material,........... If yes,type .................I........... <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,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANKS ] Size................................................ Liquid Depth ............._........... <br /> . <br /> Capacity .................... Type .................... Material._...--_-.._------ .-- No. Compartments <br /> Distance to nearest: Well ....................................Foundation ....._................ Prop. Line ...................... <br /> LEACHING LINE Noof Lines . Length of[ ] . .. ..................... geach line.---------- ........._-•-- Total Length .................... <br /> 'D' Box -----------. Type Filter Material ..................••Depth Filter Material ....................................... <br /> Distance to nearest: Well ........................ Foundation .........---.--_------_• Property Line ....__ ................. <br /> SEEPAGE PIT [ ) Depth -------------------- Diameter ............... Number .................----------- .Rock Filled Yes ❑ No Q � <br /> Water Table Depth ...................................... .........Rock Size ........................ <br /> Distance to nearest: Well ........................................Foundation ..................... Prop. Line ...................... C� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ................-•-------------------------- Date ..................................) <br /> SepticTank (Specify Requirements) ---------------------------------------------------- .............. ...................................._..........__.:.-----------••- <br /> �' <br /> Disposal Field (specify Requirements) .........jd�_o.. <br /> -------------- ................................................................. .c. -------------------------------------------.----------------------------------------•......................... <br /> .................................... . <br /> (Draw existing and required addition on reverse side) <br /> 1 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." <br /> Signed ------------------- .... Owner <br /> By ............................... eer�)__ <br /> .... Title :.---------------....................................................... <br /> (if ath n o <br /> Nx <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. .... ..........................•-•------------•---......._............-..-•-----------------, DATE ...._.... ..... �...:__......._.._.... <br /> BUILDINGPERMIT ISSUED .. ...... ............................... .................................................:..............DATE ........................................ <br /> ... <br /> ADDITIONAL COMMENTS .......................................•_.,...... - <br /> -------------------------- <br /> ................................... .. . . .. <br /> --•-•--------------•--- --- -- ----..........-•--......-----•-•----•-------------••-........... •.-----•---•--------- ---•---- <br /> ....................................................................................... ................. <br /> Finalinspection by. _.... ... ...............•--------•--•-•--........-----....................-......_....... .........Date ........ _.....� ..._.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 24 1-'68 Rev. 5M 7/72 3 M <br />