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i FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> .......... ................ . .. �- <br /> (Complete in Triplicate) Permit No. _.� ... <br /> P p <br /> ...... ........ :............................ This Permit Expires I Year From Date Issued <br /> 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 wit County Or inonce No. 544 and existing Rules and Regulations. <br /> JOB ADDRESS/LO TION `7.y. _ _. P� .--•-•--------- - � .---.-.CENSiJS TRACT <br /> ----- <br /> Owner's Name .. ..................................... Phone <br /> Address ._..... <br /> I. . ./..r . ---- E <br /> Contractor's Nam n # a� <br /> r , <br /> - _ License. - ---- --•--�------ -•- Phone ...................... <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other ------ ------- - --- ----_ <br /> Number of living units:......_... Number of bedrooms ...... Garbage Grinder ........... Lot Size ._.._...,, <br /> Water Supply; Public System and name .........:Z. ------------­----------- - <br /> ____-..____Private <br /> Character of soil to a depth of 3 feet _ <br /> : Sand It❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ <br /> - <br /> Hardpan Adobe ❑ Fill Material -------- ... If yes, type ....._....,...... <br /> (Plot plan, showing size of lot,:,location_of system in relation to wells, buildings, etc. must be placed on reverse side.) (A <br /> P. <br /> �Y <br />` NEW INSTALLATION: lNo septic tank or•seepe'pi't•peirmitted if public sewer is available within 200 feet,) <br /> PACKAGE / <br /> E TREATMENT ( ] SEPTIC TANK <br /> Size.-`T .2 <br /> ....... -1.7---- -` Liquid Depth .-V.--- <br /> Capacity - ia-aa TypeEe'�-fsA-Z Material.r�'� No. Compartments, .. . . <br /> . ...... <br /> Dis <br /> ........ <br /> ..� %`_._...._._Foundation ,..� ..f_..... ._ Prop. line .................__.� <br /> ance to <br /> f � <br /> LEACHING LINE [� Not of Lines nearest: Well Length of each line...../ ..F.-.......... Total Length ---!VR........ <br /> 'D' Box .__.a Type Filter.Material ...... .....Depth Filter Material ........ _��........................ . <br /> f jDistance tolnearest: Well y-- ------ Foundation /1t...l.......... Property line ...................... <br /> SEEPAGE PIT Depth p 6>2 ' _------- Diameter _._-�_ .-q. Number --.---- -1................ #tock.Filled Yes �No <br /> Water Table Depth ..........._dFp_ i._-N................•_Rock Size .._ .-��•�_. .��... <br /> Distance to nearest: Well ......IR;?- _,..`-----------------Foundation ... Prop. Line _. ..._..._. ...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __.-----------_-.--------,•-•--•�-- <br /> Septic Tank (Specify Requirements) r <br /> Disposal Field (Specify Requirements) ----------------------------------- ......---• ---------..1­1...... :...... <br /> -------------- ----------- ........ ... ............ ................... •--................ <br /> - ---- ---------------------- - --- --------- ----------------- ---.......... :.... . ...... <br /> ............. <br /> .---------- <br /> ...__. <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, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -- -- ------ - Owner <br /> By .... . ._ _ <br /> ..... Title . �y-d <br /> (If other than owner) <br /> f <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ._....._ ___�,-- - DATE ......� ./�. ..7..r�_•-•__-•.. <br /> b <br /> BUILDING PERMIT ISSUED . � �.).- ................................................ . ...........DATE - ----------_------- --...._...-•-- <br /> ADDITIONAL COMMENTS ... . �.._ 7'f_.... 6 ------------•--•------ <br /> •----•---------._._.............. <br /> -----•.......................................... <br /> -•-----••------ --------------------- .............. <br /> - ................. - ------ . <br /> FinalInspection by: .................... . . ..............--------•---------__7........ --.---.... ----------- ................Date ..- ... /.0 7- <br /> 7 -•-•-•-•.--•- <br /> 4 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> c <br /> �7 , <br />