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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT ?C...........................I-----._ <br /> d <br /> (Complete In'Triplicate) Permit No. ---------•...... <br /> --.. <br />......................................................... <br /> ... This Permit Expires 1 Year FrainDate Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin:Local Health District far'a permit to construct and Install the work herein <br /> described. This-application is made'IAN mplionce with County Ordinance No. 544 and existing Rules and Regulations: <br /> JOB ADDR'E_SS/LOCATION ..--1 ,. " ,/!.� <br /> -7 .................................................CENSUS TRACT ?. f..._......... F <br /> Owner's Name .................................. ....................Phone .3.... ...3jeg ' <br /> Address ....1 POO-_.'G.7_..Al..e_17qeI;r.-J�.:...........: ty <br /> r ............................... Ci .......k4_o./--.................................................. <br /> Contractor's Name.- "� , ---..�i9A1� _:,. .�L...............License .... Phone <br /> Installation will serve: r Residence 0•partment House❑ Commercial❑Traller Court 0 <br /> Motel.Q Other t..... `==• .......................... <br /> Number of living_units------------- Number of bedrooms Gdrbage Grinder . : tot Size ................................................ <br /> Water Supply: Public System and name ------ ... ' ' f Private s[}� <br /> Character of soil to_a depth of 3-feetSand,❑.,......Silt-e-,::,Cloy [Q,Peat-j]—Sandy-Loam-❑} Clay Loam ❑ <br /> 'Hardpan C7: Adobe FiH Material .,.......... If yes,type ............... ............ <br /> Y <br /> (Plot plan, showing size of lot,'location of system in relation to wells, I;uildings, 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 j ] SEPTIC TANK{ ] Size............. Liquid Depth ............... w <br /> Capacity .................... Type -----------------•-- Material...................... No. Compartments ...................... <br /> Distance to nearest: Well ------------------------------------Foundation ...........:.......... Prop. Line ...................... <br /> LEACHING LINE ( ] No. of Lines -------------------_-._ Length of each line............................ Total Length ............................ <br /> 'D' Box .....°.•__... Type Filter Material ....................Depth .Filter Material .-........................................... <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT [ ) Z• -Depth ..........._t;........ Diameter ---------------- Number ............................ Rock Filled Yes ❑ No i❑ <br /> Water Table Depth -------- ........................................Rock Size •. ........................... <br /> Distance to.nearest: Well ........................................Foundation .._.--------.------- Prop. Lina .............,......,. � <br /> REPAIR/ADDITION(Prev. Sanitation:Permit# ....... ............... Date .....----- <br /> h43 <br /> Septic Tank (Specify Requirements) �r3 ....................... ..:......................... ...............................,. ...........................j n i <br /> Disposal Field 1S,�p�e/ci�fy Requireme ts) /-------------Q.Q�w.,-....•- �L���-j�-+ -!S1 L..._. ... �����.G/.... ]�................. <br /> ------------ <br /> ----------------------------------------------------- ------------------------ -----..._.....---------.......-----..........---........... <br /> !(Draw existing dnd required addition on reverse side) <br /> I hereby certify that I have prepares) 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. Hoene 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, l shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> 4 <br /> Signed --- Owner <br /> O ----- --------- --------•-------------------------- <br /> By ----- --- �^f-- -- -------- --- - ----•--..- -------------------------------------- Title _. ~ /.. W/ . ....... <br /> {!f other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - <br /> ---if --f. -----•- � --------- --------------------------- ------------ ..7. . DATE .: $ . ......... ------- <br /> BUILDING PERMIT ISSUED .----:�---__- ---------------------------------------DATE - <br /> ADDITIONAL COMMENTS ----- -------- ,.------------ ---------- ------•••-•----•-- ­--­--­------­---------- ------ •-- ........................... <br /> ;i...... <br /> Y <br /> ........................ ...._-......--._...--"-".._.....-........._... _...__.. .__ --------------------- <br /> -------------------------- <br /> ---------------------------------•-•--- _ .__.._..------•---------------------------.------..._.------•--------------- ... ... <br /> _._.. �_ <br /> Final Inspection by: •---�"-- ---- -- -------••-------.................................................................. .._:...Dater]}. - !!._.... <br /> EH 13 24 1-68 Rev. SAN JQAQUIN LOCAL HEALTH DISTRICT 8/7h 3M ) <br />