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FOR OFFICE USE: APPLICATION FOR SANITATION PERMITS' <br /> Permit No: 7.3- ----=-- <br /> ---- -----------------"-- -------------------------- (Complete in Triplicate) <br /> --------------------------------------------------- <br /> ----- This Permit Expires 1 Year From Date Issued Date Issued <br /> ----------------------------------------- -------- - --- <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulationss. <br /> CENSUS TRACT <br /> JOB ADDRESS/LOCATION f '�'` i <br /> _ _ Phone <br /> .7--�--- <br /> f' !Z f e/V 6,/ <br /> ------------------------------- ----- <br /> Owner's Name y� <br /> City --------------------- ------------- <br /> 'T - ------- - Git � �"Y� <br /> Address y <br /> i ._ -_ Phone _ -�`( ` <br /> / [..r"f71ZUl/_�P-- - -e--- ----------.License #.� - _ <br /> Z <br /> Contractor's Name _. -- _ --- :�--.��- -- -`" / ---- ------ " - - <br /> Installation will serve: , Residence ❑ Apartment Nous ❑ Commercial ❑Trailer Court ❑ <br /> FMote! ❑Other ------------------------------------------- <br /> I Number of bedrooms --------- --Garbage Grinder ------------ Lot Size d -= -----------•------- <br /> Number of living units:__._-__(___ <br /> i Private F-1Water Supply: Public System and!name ---------- -----------------------------------------------------------------------.---------- <br /> i. Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat ❑ Sandy Loam. ❑ .-Clay Loam 0 - <br /> Hardpan ❑ Adobe [❑ Fill Material ------ --"-- If Yes,type --------------------------- <br /> i � <br /> (Plot plan, showing size of lot, side-1ilocation 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 /> :r <br /> PACKAGE TREATMENT { ] SEPTIC TANK'[ ] Size-------------------------------- -------- =-- Liquid Depth -----------------•-------• <br /> Ca acit.I --- Type --------------- ---- aterial--------- ------------ <br /> Distance <br /> ---------- o. Compartments U <br /> Di tame) to nearest: Well -------------------- _--_---Foundation - -------------------- Prop. Line ___-____-----------.-- <br /> -------- <br /> -__ Total Length -- <br /> Len Length o each line 9 <br /> LEACHING LINE { ] No. of Lines g <br /> Depth Fi er Material ---------------------------•--------•-----•- <br /> I D' Box _______.__ Type Filter Material __________________ p <br /> ------ Foundation ---- ------------- Property Line ------------------------ <br /> Distance' to nearest: Well _.___________ _ - ---- <br /> ! Diameter ---- ---------- Number "---- Rock Filled Yes 'CJ No ip <br /> SEEPAGE PIT [ } Depth _,__- <br /> ' I Rock ize <br /> Water Table Depth --------------------- ------ <br /> Distance)to nearest: Well ----------- �___________________ <br /> ------Fo dation -------------------- Prop. Line ------• ••------------ <br /> I ----------- Date ---------------------------- <br /> REPAIR/ADbITION(Prev. Sanitation Permit _______ _----------------------- <br /> I --------------------------------- <br /> -------------------------- - <br /> f Septic Tank (Specify Requirements) ------------------------ - <br /> ls -- ,L� --------=-------------- <br /> i Disposal Field (Specify Requirements) "" <br /> ------------------------- <br /> ---------- - <br /> --. .�.� <br /> ------------------------------------- -- - - <br /> ' (Draw existing and required addition on reverse si e) <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 /> sed agents signature certifies the following: <br /> ce of the work for which this permit is issued, t shall not employ any person in such manner <br /> "1 certify that in the performan <br /> as to become subject to Wo man's Compensation laws of California." <br /> i Owner <br /> Signed <br /> - -- - ------------- <br /> --------- <br /> - Title --- -------- ---------------- ---- <br /> ---- - ------------------ -------- <br /> - ------------------------------------------ <br /> - <br /> Y --- - -- <br /> (If of e than owrie <br /> FOR DEPARTMENT USE ONLY 7 <br /> APPLICATION ACCEPTED BY _.�-------�`---- ---]?---------- ----- <br /> -------------------- --------- ---------------- DATE - -- ---I-"---A - ----"""Z�-- <br /> BUILDING PERMIT ISSUED _----- <br /> -------_DATE ------- ------------------------------•---- <br /> ----------------------------------- <br /> ADDITIONAL COMMENTS - ----------------------------------------------- <br /> -------=--------------------------- - ------- -- ---------------------- - ------------ ------ -- ------------- ------------ --------------------------------------------------------------- <br /> t f ► <br /> -------------- ---------- ---"_Dae ---- --- ­1---- <br /> s <br /> f--- <br /> Final lnspec i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> _ E. H. 9 1-'68 Rev. 5M <br />