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FOR OFFICE USES <br /> APPLICATION FOR SANITATION PERMIT r. <br /> ..................................... ....... Permit.in Triplieatel w _ Permit No. . <br /> .. .......................... <br /> ...............:..............:.......................... This Permit Expiros 1 Year from flesh isseted Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to coristnict and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and-existing Rules and Regulations: <br /> JOS ADDRESSAOCATION ....................._........CENSUS-TRACT ._...:................... <br /> Owner's Name ...,l l'" ,/ ,. l -.. ...............................:............."....Phone .............................. ------ <br /> Address ,/ ,.... f... .. ...:.. ..................,... .:City S . ---- ------- ........................................ <br /> Contractor's Name _ _ .. .:-,e� ............::...............Ucense #4710Y.?.. Phone�_.4- 0K.. <br /> Installation will serve: Residence Pd Apartment House J3 Commercial OTraller Court 0 <br /> Motel❑Other <br /> Number of-living"units:-...`.._ Number of bedrooms .A�..Garbage'Grinder &Z.. Lot Size _,? ...l.. _f ............ <br /> Water Supply: Public System and name .JOA&f:....11Ll ... K%L:°� ....................................:Private-0 <br /> Character of sail to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Oeat p Y <br /> $andy Loam 0 Ciay Loam 0 <br /> Hardpan 0 Adobe Fill Materlol ............If yes,type.....•......... .. ..... <br /> (Plot pian, showing size of 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 public sewer is available within 206-feet.) <br /> PACKAGE TREATMENT .( ] SEPTIC TANK{ } Sizes......:.......................::..............:. Liquid Depth .......:.........,. ...� <br /> i Capacity --•............... Type ......................Materlal...................... No. Compartments ...................... <br /> ­.,.,aDistance-to.-nearest: Well ................................... .foundation ........................' Prop line...............».....N <br /> LEACHING LINE } J No. of Lines g ng <br /> . ................. ...... Length of each line------------- .__..._---� Total Le th <br /> 'D' Box Type Filter Material .....Depth filter Material 0 <br /> Distance to nearest; Well .... Foundation <br /> .:.... Property Eine :...:...:.............:.� <br /> SEEPAGE PIT [ 1 Depth .................... Diameter ...........:..... Number ........ ._.....__._..._._. Rock Filled Yes ❑ . No <br /> Water Fable Depth" ..: Rock Size <br /> Distance to nearest: Well ................ ......Foundation .... prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit 0 __...._..._........:...............:........ Date..........:.............:...:.....} , <br /> - - <br /> Septic Tank (Specify Requirements) ................. .................:_.: 7 .................. ._._.... :....f '- ....... <br /> �` / r <br /> Disposal Field (Specify RequireMents} .--- (. G�._ _._ t ...._,Er�.ef� :.� - - -.-........ <br /> 2. .. '..... L v. ... ...... ............................. <br /> --------•-------- -------------------------------------------------------------•----------- ••... ----------•--•-- ----•- ................. ..... .... z. <br /> y (Draw existing and required addition on reverse side} ;. " <br /> I hereby certify that I hove prepared this application and that tits work will be done in occordaria with San Joaquin <br /> County Ordinances, State Laws, and- Rules and Regulations of the San Joaquin katal Hecelsk DIstriil. Hanes owner or liven• <br /> sed agents signature cerFifies 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-Jaws-of'California <br /> .'- <br /> Signed Owner <br /> o <br /> By .. ! . -- Title . . <br /> ..................................... <br /> 11 other t an ownerl <br /> R D RTMf T USE ONLY <br /> APPLICATION ACCEPTED BY .....4f .. ...........DATE ..... ...... ...........77................. <br /> BUILDING PERMIT ISSUED -..-------- .. . ....... .. ...:....................--------------- ----------------=----.-DATE ....-------.-._....----------------------- <br /> .ADDITIONAL COMMENTS ..................... ...............................................--...........-..............-.:................... <br /> .......................................... ---- ...... .. ... <br /> .-....-. .- ...................................... ..._...._....... <br /> ..- .....,/ <br /> ..._ '------�� ....... <br /> Final Inspection by .....Date ............................ <br /> Edi 13 2Z 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT3.M <br /> , .. <br />