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FOR OFFICE USE: Z,-,— 6 e- 7�`3 <br /> ,APPLICATION FOR SANITATION PERMIT a7>r <br /> ------ - ------ ........... ------- Permit No. <br /> -�--•�----------� f (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'lCounty Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION . .d. � �: _ CENSUS TRACT - ------------------------ <br /> Owner's Name -- L�"'�`�'Y----------- - Phone._L. �`_ �e..__.. <br /> Address --------------------------- ----•- •. . ------ ----- ------------------------------------- ... City - -•---------------------------- --------------------------------........._ <br /> Contractor's Name --------- --------- ----` ---- -- t_�=` ----------•------..---.-.-----.License# ----- - ------------ Phone V6 Fi 07_. <br /> Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court Q <br /> Motel ❑Other ----------- ---------------------------- <br /> Number of living units:-- 4----- Number of bedrooms _._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 El Clay-Loam❑ <br /> Hardpan Adob 'e Fill Material ........_... If yes,type---------------_-._......._ <br /> t <br /> (Plot plan, showing sizelof 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 publics&er is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK I ] ��}� ` Size............. --------------I---- Liquid Depth . ---------------------- !A 1 <br /> opacity ...... ---- - - �TY <br /> Ca Pe� - Material No. _Compartments ...................... �1 <br /> Distance to nearest:tWell' . L���:_....:..........:. ;,Foundation --.._-_-.�__--.._._ Prop. Line -__.....__.--.:.._-____ <br /> ,, d + - , _ _. <br /> LEACHING LINE [ ] No. of Lines ..........._`_..- Length Hof each line------,......................Total Length ............._-------_--__- <br /> ��__I <br /> I <br /> 'D' Box ....... . -- Type Filter Material --------------- 5epth Filter Material -------.---_-------------- ................. ' <br /> 1 ' `to '-"'^`-"-,_-Foundation-----�._:_ Pro <br /> Distance to nearest: W�11----- ---------------- ......---------.. petty Line ---- .-. ......---=---- <br /> SEEPAGE PIT [ Dept ©YDiamete ___ ..- .. Number ........................... Rock Filled Yes ❑ No i❑ <br /> Water Table Depth ,......... r--.__•d--..._`..............Rock Size ----•-••---.------- <br /> - ------------- <br /> ` <br /> Distance to nearest: Well --------------------I------------........Foundation ____-__.--.._-_-____ Prop.a Line ---------------------- <br /> REPAIR/ADDITfON(Prev. Sanitation Permit#s.---------------------------�----..,..-..-- Date --.--------_-_----..-------•-.----) <br /> Septic Tank (Specify Requirements) --------- `- - ---- �:- -A-------- ` ................. ............ - <br /> Disposal Field (Specify Requirements) --- -. D� -- ----•-• ------ <br /> . .. ... ....... <br /> --ate ------- �f <br /> t ! --------------- ------ <br /> { (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 I <br /> as to become subject to Workman's Compensation laws-of California." <br /> Signed f� . .................................. <br /> ..._.. Owner -...� <br /> f <br /> BY .. ----- - - ----- �. ^...... ..! --.. Title . . .......... .. ..�. - ---------------------------------- <br /> (If oth tat{'owner) t ] I <br /> t <br /> DEPARTMENT USE ONLY <br /> APPLICATION AC EPTED BY :..`.---•------� -- ------ --------••--•------------- ...... DATE I./........ <br /> BUILDING%PERMIT ISkED -----------•--•-----•----•-----------------•-----•----------------- <br /> ••••-- _ -----DATE ------------ ------------_-- -- ....---- <br /> ADDITIONAL�'COPAMENTS----------------- --------•- ----- ------- ----------............------ -----------------------.--.-------- -=- ..................... <br /> - - .................. ........................................................... ...........I------ - -- - .......... -- ------- ------ <br /> •--•-••. •. . -------- x' ---------•-•----------------------------- ••--- -- ••--..............---• ••--•---------------------------------• <br /> ��� r --------- <br /> Final -- <br /> VAV <br /> Final Inspection b __ ... (r ........................................................... ..Date --- `L Sr, <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br />