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FOR OFFICE USE: ,IC�iTION FOR SANITATION PERMIT <br /> ' <br /> - ---------------------------------------------- Permit No. -C-�=---�_ _ <br /> (Complete in Triplicate) <br /> - ---------------- ------------------ ------------- ---- <br /> /..-3s�.--_- "" <br /> ----------------_---------------- This Permit Expires 1 Year From Date Issued 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 <br /> iwith <br /> ~�County.Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _- 1p. {`>4-----.-R,00 -------------- <br /> - CENSUS Tt�ACT = <br /> Owner's Name�,_, � ^� �" � �-----------------"------------------------------------------------ -------Phone - -� b -------------- <br /> Address ----- '`'C%------------------- --------------•--------------------- - -------------------- City ---------------------------------------------------------------------•--- <br /> s <br /> Contractor's Name --------------------- - -----------------------------------------------License# --------- --- -�- Phone ------------------------------ <br /> Installation will serve: Residence�A artment House Commercial Trailer Court <br /> 1 <br /> Motel ❑Other -------------------------------------------- r / <br /> ii - <br /> Number of living units:".---.L----- Number of bedroom ---_Garbage Grinder tot Size -� --X - <br /> Water Supply: Public System and name --- --- \F_Wf� Cr-� �V�t�- ------------------------------- --------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam-:❑ , <br /> Hardpan C] AdobeX Fill Material -Kb► lf yes; type ----- --------------- <br /> (Plot plan, 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�s6,,er is available within 200 feet,) �1 <br /> PACKAGE TREATMENT f ] ";SEPTIC TANK'{ I Size--------,r �---- -- ----------•------------ Liquid Dept ---------------- --------- <br /> ----------- <br /> -- ----- -- -- -- <br /> - Type -------------------- Material`:--------------------f,No. Compartments ------ =------ 1I' <br /> Distance to nearest: Well -------------------------------'_:,Foundation ---.17----------------- Prop. tine -----------------.---- <br /> LEACHING LINE [ ] No. of Lines <br /> . --�"�,`.�'...'�""-..- l:ength',of each/line--------------,-' - Total Length ----------- ------------- <br /> . ) <br /> Type Filter Material----t- ----- Depth--Filter�Material -------- ----------------------------------- <br /> ~~ -- Rock Filled Yes t <br /> fance to nearest: Well ----------------- ------- <br /> ----------------';- --i Foundtition -- ----------------_---- Property Line. ------------------------ <br /> �. <br /> SEEPAGE PIT f ] Depth - ----4------ ----- Diameter --------- ------ Number --------------,-------- <br /> � 0 No C] <br /> - - - <br /> Water Table Depth --------------- ----------- --------------------Rock Size -------- -------------------- <br /> t Distance tofnearest: Well --------------------------------------.Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ DDITION{Prey. Sanitation-Permit,# -_.._-`-`— -` 3 -------- <br /> P <br /> ) 1 <br /> f <br /> r <br /> ---------- Date ---- �- ------ --- •-- <br /> t € I NIVArm- <br /> Disposal <br /> aSeptic Tank (Speci'fy Requirements) _ p--`j 1.h�----tJJ1 ----1- -.fir --� 'te�C�Field (Specify 'RIf equirements) -------------"- `" <br /> r <br /> ---------------------------- ------------------------------------------- ------- ---- - - - --------- -- -------------- ------ ------- -.------- <br /> (Draw existing%and required addition on reverse side) <br /> f <br /> I hereby certify that 1-hha—a prepared`this'ap lication`arid that"the work*will,be'd`one1 arcordaiiie 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 /> "t certify that in the performance of the work for which this•perdnitis issued, I shall not employ any person in such manner <br /> as to become jest to Workman's Compensation laws of California." <br /> Signed4_. -- _ Owner <br /> BY ------------- Title --------------- ---- - ------ ----------------------------------------- <br /> (!f other than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED -BY -" . <br /> - `'"�------ -------------------------------- DATE ----- --��--' - -------- <br /> BUILDING PERMIT ISSUED -.---- - -� �- -------DATE ----------------------------- <br /> - -------- -- '" - <br /> ADDITIONALCOMMENTS ----------------------------------------------------------------- --------------------------------------------------------------- --------•-•---------------- <br /> ------------------------------------------------------------------------------------------------ <br /> ----------------------------- ------ -------------------------------------------------------------------------------------- ---------------------------------------------- ------------------------------- <br /> ------------------------------------------------------------------ --------------------------------------------------- <br /> -------------------------------------------------------------------------- - <br /> FinalInspection by- ------------------------ ------------------------------------------------------ ----------------------------Date -------------------------------------------- <br /> i -- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M. <br />