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•sem _.. � � k <br /> FOR OFFICE USE: APPLICATION FOR`SANITATION PERMIT <br /> -- .V- --- ------------ ----------------------------------- <br /> Permit No: ____�.3'3_q-•. <br /> ` C <br /> \� Date issued <br /> This Permit Expires Y Year From Date Issued <br /> - ' <br /> i <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 /> -y� <br /> -------- CENSUS TRACT -- <br /> JOB ADDRESS/LOCATION ...-./_ "t---- - ,-- ---- <br /> ---- <br /> Owner's Name <br /> --- Phone <br /> Address -------------------- ---� - <br /> -�y CitY - ----------------- --------••-- <br /> -Sv <br /> 6. <br /> Contractor's Name ----------- ---- -------S.-`1""V------------- ------ <br /> License # �UDSI(.------ Phone .c4 1�----�-------•- <br /> installation will !'&Ve: 'Residence Apartment-House❑ Commercial ❑Trailer Court ❑1 -- --- <br /> Motel ❑ Other -------------------------------------------- <br /> JJ � <br /> --- 1--- ----------------- <br /> Number of hying units.--- ------ Number of bedrooms ---..._._...Garbage Grin der ..__- Lot Size -..-_ __�- <br /> `I -----Private ❑ <br /> Water Supply: Public System and name _--_.___..._ --_ <br /> --------------- <br /> Character of soil to a depth of 3 feet: Sand'E] Silt fl Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ <br /> Hardpan ❑ Adobe XTFill Material - ------ If yes, type ---- ----------------------- <br /> k ' 1 cation of system in relation to wells, buildings, etc. must be: placed on reverse side.) p <br /> (Plot plan, showing size' of-lot,Io Y ._. ; N <br /> NEW INSTALLATION: (No septic tank or <br /> seepage pit permitted if public sewer is available within 200 feet,) <br /> '``'`SEPTIC TANK; Size------ --------------- ----=------' - ---•-Liquid Depth ------------- ------------ <br /> - J'.TREATMENT [ ] ­ ._ [ ] - k'� ,x <br /> r`—.i= . <br /> Capacity ---------------------- Type -------------------- Material----------------- No. Compartments = <br /> Distance to nearest: Well ___.------- - <br /> " i iFoundation.`. ----------------- Prop. Line ------..-_... -------- <br /> ------------- Length of each line.. Total Length <br /> LEACHING LINE [ ] Na. of Lines � - g - <br /> D' Box ------ ---—Type - Jri - --- Fo+--ndbtDepth Filter Material ------------------ <br /> _ Filter Material <br /> Distance.to-nearest: Well <br /> Foundation• ----------=V------------ Property Line. --------•--------.------ <br /> ' Numbe; 4 Rock Filled Yes ❑ No ,O <br /> SEEPAGE PIT' L l Dept Rock -- <br /> --------------------- <br /> lame Diameter <br /> [ Fours <br /> Water Table*Depth Size -____ --�--- ------ <br /> ------------------ -- <br /> l. i <br /> ` dation `----- Prop. Line --------------------•- <br /> Distance to nearest: Well ---------------------•------------ ---- <br /> i ---------------------- Date --------------- --------------- <br /> ) <br /> REPAIR/ADDITION(Prev. Sanitation Permit e#:---------f--- ---- - � <br /> Septic Tank (Specify Requirements) ------------------- -------------------------------- <br /> Disposal Field (Specify Requirements} ...___ ----------- 0 -- -.__..._ <br /> ----- ----------e----- ----- - ----------------- -------------------- -------- <br /> } C s ----------------------------------------------- <br /> ------------------------------ <br /> I .I (Draw existing and required addition'on reverse side) <br /> I hereby certify that 1 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 /> see[ agents signature certifies the following: <br /> "1 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.''__�.. , ». , ' 11 <br /> Signed - <br /> ------------ <br /> Owner <br /> ------------------ Title <br /> -- --------------- <br /> (If of than owner) <br /> I FOR DEPARTMENT USE ONLY <br /> -------. DATE_---_1�--a�' -----------•------ <br /> APPLICATION-ACC -PTED-BY„-=- - ----------- ------ -- _: - _ _ - <br /> BUILDING PERMIT ISSUED --- --- -- -------------------------------------------- ------------------- <br /> ------------- <br /> ----------------- DATE - <br /> - ------------------- <br /> ADDITIONAL COMMENTS == _- ---------'------- ------------------------------ -------------------------- ------------- <br /> --------•---- <br /> ------------------------------ ------------------------------------------------------------------- - <br /> I---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> k s ----- <br /> - - rl <br /> ------- <br /> --------------------------- . _ Date _ ----- ----- -- <br /> --- ------------------------------------------------------------------------------------------------------- <br /> Inspection b <br /> ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F. H. 9 1-'68 Rev. 5M <br />