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w -FOR OFFICE USE: APPI.ICA'TIOIN FOR SANITATION PERMIT <br /> Permit No. 3.0.3 <br />....... ............ ................................. ...75- . . .. .. <br /> (Complete in Triplicate) i <br />........................................................ This F'emit Expires Year From Date Issued <br /> Date Issued .................... �. <br /> Local Health District for permit to construct and install the work herein <br /> Application is hereby made to the San Joaquin La p o <br /> described. This application is mode in compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..�r . ... _...._�` <br /> CENSUS TRACT <br /> Owner's Name ....... <br /> w�. _ ....................... <br /> ...P..._ v. - � <br /> ...l,l ' r Irl . ............................ ......................... .....................Phone .................................... <br /> Address ......41.16.49 �.....X.... _ .. .��......�. ............... <br /> .. Ci ease # � .. ..........._ <br /> Contractors Name .._. .. .... . ...... .....� �........... "`�-- _-.Li �� _�- Phone <br /> Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court i❑ ' <br /> ii ' <br /> Number of living unity............. Numberof <br /> ❑Other ------------------•.---------------_----- •- <br /> bedrooms .....'.l._-__Garbage. Grinder -__--.__..-. 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 C❑ Fill Material _........... If yes,type _----------_---_-_------ <br /> (Plot <br /> ----------_--- -_------ <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 TANK f ] Size..............•-__.....__._....._...--__..._... Liquid Depth .........-...------....... <br /> Capacity ......__.......... Type ------ -•--•---_ ... Material...................... No. Compartments ...................... <br /> j <br /> Distance to nearest- Well ....--------------..........•...--__Ioundation ...................... Prop. Line ...................... <br /> 1� <br /> LEACHING LINE [ ] No. of Lines ---.-------_----1M:----. Length of each line------...................... Total Length ........................ <br /> 'D' Box ------------ Type Filter Material ....................Depth Filter Material .........................--............. <br /> :--. O <br /> Distance to nearest: Well .--_-------_--- ...... Foundation ........................ Property Line ........................� <br /> SEEPAGE PIT [ ) Depth .............:...... Diameter ................ Number .....-.--------_. .......... Rock Filled Yes ❑ No 0 <br /> Water Table Depth .......1[ Rock Size <br /> k Distance to nearest: Well! p• ` <br />� j ----•--......---•--•----•- •-•---------Foundation ----•-•------------- Pro Line _.........-----..._.._ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...... .................................... Date .................................. <br /> Septic Tank (Specify Requirements) ..................(----------_------ ...................................................................,........................... E <br /> Disposal Field (Specify Requirements) __ � ..... -------------------- .._. _... <br /> jrt^ ... 1 Hca ------ <br /> k <br /> �°. <br />, ------ ---- ------------------ ------ - --- =r'---- -•-- - ._. . ....._.fir. <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. Hoene owner or liven. <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .................. _.... ....... .......•... ................ Owner <br /> n <br /> By . ..................... .._._ -!4........, - Title ...96-1s_,(A -4Jtr.1.......................................... <br /> (If other than owner) `! <br />' FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ............ �-------- ..................................... .................. DATE ... ... ............. <br /> BUILDING PERMIT ISSUED .... .._..-- - -... !k...... ....... . . ....-- DATi: ....__..._--•• <br /> ----------- <br /> --•- .......----•-----••......-- <br /> ADD1TlONAL COMMENTS ... -r321 - ............................................................ ........ <br /> ..........................................1,......... ......--•--•--•... .'I' ._._.....................--- ..... --.------------.._.........--------.----.---- ................ <br /> I <br /> Final inspection by: C .................................................... ..........................•---- --- Date -- .. . ...........-- <br /> ,i <br /> SAN JQAQUIN 'LOCAL HEALTH DISTRICT_ i <br /> '. _ .. <br /> 14 W. .._ . . .. �� 71723M <br />