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FOR OFFICE USE: -7 T4 <br /> APPLICATION FOR SANITATION PERMIT Permit No ----------------•--- <br /> - -------------- ' (Complete in Triplieafel <br /> - ---- --- i�-ate-731- <br /> 5-:; <br /> Date issued - ---- <br /> - ----------------------- <br /> ----- ---------------------•------ ---- -- <br /> This permit Expires 1 Year From ate issued <br /> Health Ruins and Regulations.. <br /> Application is hereby made to the San Joaquin cwith CountytOrd Ordinance No. 549 anrmit to d eruct 9 d ins and <br /> the work herein <br /> described. This application is made in compliance <br /> CENSUS TRACT <br /> JOB ADDRESS/LOCATION ------ - -k/� ¢ '" .��Phon1 <br /> S 7 <br /> e - <br /> Owner's Name ------ ---------- ----------- -- ---- ----- - - -- - -------- <br /> ----------- <br /> - <br /> - -- --• <br /> --- --- ----------- - - - <br /> CitY> --- <br /> jj f � j fl <br /> Address 3 A----- (�` � � <br /> --- -- �- ,� Phone ---------- -------- <br /> !� _ l� License # --•- <br /> ----�-- .tom - - - - - <br /> Contractor's Name --� " --" <br /> Residence�Apartmen# House❑ Commercial:❑Trailer Court 'E]Installation will serve: <br /> Motel ❑Other ------------------------------------------- <br /> v \I Number of living units:-__/r------- Number of bedrooms ------------Garba-ge Grinder _____-"_.- Lot Size ------------------------------- <br /> Number <br /> ----_-" Private �J <br /> -------------------------------------- <br /> Water Supply: Public System and'name ------------------------ Peat❑ Sandy Loam ❑ Clay Loam 13 <br /> Character of soil to a depth of 3 feet: Sande Silt❑ Clay ❑ <br /> Adobe Fill Material ------------ If yes,type ------ --------- <br /> i + Hardpan ❑ ❑ ` <br /> I (Plot plan, showing size of lot, location of system in relation to wells, <br /> buildings, etc. must be placed on reverse side.) <br /> F <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> Size ------ - Liquid Depth ----- ------------------- <br /> SEPTIC TANK't ] ' ----• ---------- - - ------ ----- - <br /> PACKAGE TREATMENT ( ] No. Compartments ---------- ----------- <br /> Type Type -------------------- Ma rias- ----------- p <br /> Y - ----------- - <br /> f Dpsan i 1 to nearest: Well ------ --- --! undation Prop. Line <br /> E LEACHWG LINE [ ] No. of lines -_------ - ------------ Length of each li e-----.-------------- <br /> Total Length ---------------------------- <br /> 'D' Boz'------------ Type Filter Material -----_. -Depth Filter Material -------------------------------- ----------- <br /> 'D' ---- - <br /> undation --- Property Line ------------------------ <br /> I Distance to nearest: Well ____.__-"--- -------- -- - Rock Filled Yes ❑ No �❑ <br /> SEEPAGE [ ] Depth �.I----------- -- <br /> ----- Diameter ------------/Number ----------------- <br /> Water Table Depth ----------- -----------------------------------Rock Size -------------------------------- <br /> I <br /> ------------------------ -•--- <br /> ---- Pro Line ------------->-------. <br /> Distance to nearest: Well _ -------------- Foundation --" P <br /> - ----------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit <br /> --------=- <br /> - ------------------ <br /> Date ---------------------------------- <br /> tion <br /> Septic Tank (Specify Requirements) ___--- ------------- <br /> ------------------- <br /> ------------------------------------ ---- ------------------------- <br /> r _ - <br /> Disposal iey pecify Requirerpents -----------------------•-- ---------------•----- <br /> � : _ --- <br /> - -- <br /> -� ---------------- ------------------------------- ----------- e - -- <br /> - - <br /> (Draw existing and required addition on reverse s e <br /> that the work will be <br /> done in <br /> h Son <br /> uin <br /> I hereby certify that 1 have prepared this application <br /> and Rules and Regulationsof the San Joaquin Local Health I)isfrcf nlHome ce ifowner or liven <br /> County Ordinances, State Laws, <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 /> i on ' so <br /> f California." <br /> as to become subject to Wor ' an's Compensati <br /> ------.- Owner <br /> i Signe <br /> " Title _.-- ------- ------ -------- -------------- - <br /> -- ----- - ----------- <br /> (If other than _wnerl <br /> -` FOR .DEPARTMENT USE ONLY y'C�_? <br /> - --------� DATE ---�� ------- --•--- -----J------ <br /> -- ------ ---- ------------------------------------------ --------- DATE ------------ ----------- <br /> APPLICATION ACCEPTED BY -------------------- ---- ----�----"" <br /> ----------------=----- <br /> ADDITIONAL COMMENTS ". <br /> BUILDING PERMIT ISSUED _ ----- ----- ------- ------- "----- --- --- ------- ------- --•--- ----- ------- <br /> �-------- -- ------ ---------- -------------------------------------------- -------------- ----- <br /> ---------------------------------- <br /> ----------- ----------- F --------------------------------------------------------------- �,►L 2 + <br /> ---------------------- D <br /> ate _ ���--- <br /> - <br /> Final Inspection b <br /> p SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br /> E. H. 9 1-'6$ Rev. 5M <br />