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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permit No: �1-1 <br /> r "-- -------- (complete in Triplicate)-------------------------------------------------- <br /> ---- <br /> --- - Date Issued -- - =------------ <br /> --------- p <br /> This Permit Expires 1 Year From ate slue <br /> Application is hereby made to the San Joaquin Local Health District fora p <br /> ermit to construct and ins#all the war herein <br /> described. This application is made;in compliance with County Ordinance Na. 549 and existing Rules and Regulations: <br /> j --CENSUS TRACT -- -- <br /> G /31------�---a <br /> --------- ---- <br /> ----------- <br /> JOB ADDRESS/LOCATION ----- --� ----_ �--- - --- --------Phone -----------------------V------------ <br /> ------------ - <br /> Owner's Name --"---- <br /> -- �-�_+f�_1�_ ----�---� ----��------------- -------•--� City - ---�-- - --- --.---: ------•�--- - - -- <br /> Address ------ ------------ ! Phone ----- • ---------- <br /> --- ---------------------------------------------------- <br /> _ License ------------------------- <br /> Contractor's <br /> - --:- .----- -�--- - � <br /> Contractor shame` "'` I Commercial ❑Trailer Court i❑ <br /> Installation will serve: <br /> Residence I Apartment House❑ <br /> Motel ❑Other -----------------------I---- --------- ------ <br /> --- ----- ----- =- ------------------------ -------------------------•----• <br /> Number of living units-----I------- Number of be ------------Garbage Grinder _____________ Lot Size _--- private ] <br /> I -' <br /> Water Supply: Public System and name --------------------- peat❑ Sandy Loam. Clay Loam� <br /> Silt❑ Clay ❑ <br /> —y <br /> Character of soil to a depth of 3 feet: Sand'❑ �_ _ e ----------------------------- <br /> Hardpan f,� Adobe Fiil Material -__--------- If Yes, type <br /> r buildings, etc. must be placed on reverse side.) <br /> (Plot plan showing size of lot, location of system in relation to wells, <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> t -------------------- Liquid Depth ------------ ` <br />' SEPTIC TANK'[ 1 Size---------------•--------- - - <br /> i PACKAGE TREATMENT [ <br /> Type Material No. Compartments -------------•-------- <br /> l Capacity ---------- yp Pro Line ---------•-----_----•- <br /> -- ---- --------------Foundation ----------------------- p• <br /> 'Distance to nearest, Well ------------- ------------------ Total Length .- ;------- --------•------- <br /> j <br /> LEACHING LINE [ ] ines -"------- - -- ----- --- Length of each line <br /> of Lines <br /> Type Filter Material ____________________Depth Filter Material _____-"_------------•------•----•--�--'--•'• <br /> F 'D' Box i --------- Yp Property Line ------------------------ <br /> Foundation ------------------- <br /> Distance to nearest: Well ------------------- ------- Rock Filled Yes 0 No id <br /> ' Depth --"_- -- Diameter ---------------- <br /> Number ---------------- <br /> SEEP� [ 1 p -_--_ <br /> + --------Rock Size - ----- -----------•--•-•------- <br /> Water Table Depth -------------------------------•----•-- Prop. Line ---------------------- <br /> Foundation -------------------- <br /> Distance to nearest: Well ------------------ - j <br /> nk S euf Requ+rem ,---- --------------- -------- <br /> Date -------------- <br /> k RE5APR/cA aD{TION(Pryv.5an�tat ora Permit t#I - - - -------------------------------- ------------------ <br /> •---------- ---- ----- -----'------------------ --- <br /> ., <br /> irements) ---- � <br /> Disposal Field ISPecifYRequ <br /> --------------- <br /> ---------------------------------------------- --- ----------- <br /> ------------- ------------------- <br /> ----------------------------- <br /> ---------- --------------------------------- <br /> ---------- V <br /> --- �--� - � Draw existing and required addition on reverse side) <br /> b cerci that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> I hereby certify - <br /> Count Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or ice <br /> � y ersan in such manner <br /> L sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which lbws of California." <br /> permit <br /> isissued, I shall not employ any p <br /> F as to beta a subject to Workman s R <br /> ------------------------ <br /> Owner <br /> Signed - u . <br /> Title -- ------ -- -- <br /> -------------------------------------------- <br /> ----- ----- �---� ----- -�-- -" -----�- <br /> ------------- <br /> (If other than owner) <br /> I FOR DEPARTMENT USE ONLY - - /7 M <br /> DATE -`-� ----------?/ <br /> ---------•--•------ <br /> i APPLICATION ACCEPTED BY - ------- <br /> ------ - ---------- ----- ------------- ---------� ----- ----- -�---- ------ ----- DATE . -- -- ----------- ---------------•-�----- <br /> BUILDING PERMIT ISSUED ------ - ----•---- --------------------------- <br /> ---------------- ----------------- ----- <br /> ADDITIONAL COMMENTS s ----------- ------ ---- <br /> ----------------- -------- --------------------- - ----- <br /> ----- -;-,--- ----- ----- ----- - ----------.Dat 7V-- - <br /> Final <br /> ---- <br /> Final Inspection by: - - - <br /> - ----------------- - - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Ll in I_'AR Rev. 5M - - <br />