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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------- --------=---------- Permit No. <br /> ---------------- [Complete in Triplicate) �--- <br /> --------=----`------------- ----------------------------- Date Issued <br /> _,- _------------------------------ 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 /> ^ J'OB N� ------------------------------------------------------------------CENSUS TRACT ---- ---------------_-. <br /> �.r ADDRESS/LOCATION ._ ___ �'�_. ��lld'?_ <br /> Owners Name -----------------I_IZ{L4'----G"_ rJr 1 ��-,-�� - d - hone = -lQ <br /> Address ----------------------------------rrw<----Opi-------�-L -� City <br /> Contractor's Name --- ---------------- ' .Vkb ---------------------------------- -------.License # -------- Phone ------------------------------ <br /> Installation will serve: Residence 201(�artment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other -------------------------------------------- ` <br /> Number of living units------/----- Number of bedrooms ___0----Garbage Grinder VC?---- Lot Size --_______-� -,---- »t ) <br /> Water Supply: Public System and name -------------------------------------------------------------------------------------------------- -----------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Sift[] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> w..­._..^- �- THardpan0- Adobe Fill Material,-=f_b---..ifyes,-type--- <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;( uize_ <br /> _-] _ --------- ------------ Liquid Depth ._ _' --------------- <br /> Capacity __---_-- Type - -•--- Material---ft- ----- No. Compartments ----�.------ <br /> •.---- <br /> Distance to nearest: Well i 47:-ti________---_Foundation _--- ------------- Prop. Line _l6i_0______________ <br /> LEACHING LINE [ ] No. of Lines -----Q--------------- Length of each line-----9- -------------- Total Length _14b <br /> U <br /> 'D' Box Type Filter Material ____ _: ______Depth Filter Material ___Is <br /> __�_V__y____________________________ <br /> Distance to nearest: Well __20 ___________ Foundation ____Do Property Line. _____-:.... <br /> SEEPAGE PIT [ ] Depth _ ________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes F] No 0 <br /> Water Table Depth ------------------------------------------------Rock Size --------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------------------__ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- <br /> Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------- _------------- ---•-------•--_--------------- <br /> Dispo'saf Field !Specify Requirements) ---------------------------•--------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------`------------------------ <br /> ------------------------ <br /> --- ---- -- --- - - ------------ --- <br /> r - (Draw existing and required addition on reverse side) <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 licen- <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 <br /> ---------------------- ----------------------------------------------- Owner <br /> By/--- - --------- <br /> Title -------- ----------- --------------------- ------- ---------- --------- <br /> (If her than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> ---------------------------------------------------- -----------. DATE ---- <br /> BUILDING PERMIT ISSUED ----------------------------------------------------------_--------------------------------------DATE ------------- -------- J------- ---------- <br /> ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------- ----------------------------------------------------------- ------- <br /> ------------------------------------------------ <br /> ----------------------------- -------- -------------------------- <br /> ------------------------------------------------------------------------------- --------------------- ------ <br /> ----- ------ <br /> Dat - <br /> Final Inspection b SA OAQUIN LOCAL HEALTH. ISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />