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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> t ___________________ Permit No.7- -_(1'7.-� <br /> a (Complete in Triplicate) <br /> -----------1------- ----------------------------- ----- <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 mdde in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ---- CENSUS TRACT <br /> -------- <br /> Owner's Name /j�� L�U��f ----------------------------------- --- --------------Phone----- <br /> W2-05316 <br /> Address ...CF- 111----- -------------------------------------------- City _5 � f'' <br /> Contractor's Name ���.�-1 T7e-_ ----�1"�� License #19Phone t�Y- . 7 <br /> Installation will serve: Residence%Apartment House Commercial :❑Trailer Court !❑ <br /> Motel ❑Other ---------------------I----------------------- <br /> Number of living units:--- _ ----- Number of bedrooms -a�.-------Garbage Grinder A10---- 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 ❑ Clay Loam❑ I <br /> Hardpan ❑ Adobe fid Fill Material --------- -- If yes, type --------- <br /> plan, showing size of lot,11ocation of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> I <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK X Size- �1( 1 ` -- --�----------------------- Liquid Depth --/-------------------- <br /> Capacity Typeffi�-r4?0--- Material No. Compartments ________________ <br /> Distance to nearest: Well'"'_��_____--________-Foundation __�G_�__--- -__ Prop. Line __1_____________ <br /> J i � <br /> LEACHING LINE No. of Lines ----___I______________ Length of each line------ Ql-I__.______ Total Length _�lQl��_.____________ <br /> 'D' Box <br /> _-_ Type Filter�Material _ '4'C _-Depth Filter Material ___If--�-_ <br /> Distance to nearest: Well-77=------------- Foundation ---/a----------------- Property Line ---�______-----•__ <br /> ' f � it <br /> SEEPAGE PIT J(] Depth __1jf' ___ Diameter 3K----_---- Number 1___-____/_ ___ -. Rock Filled Yes ] No <br /> Water Table Depth ---11700---------------------------------Rock Size -f-------------- <br /> Distance to nearest: Well ----- -------------- ______________Foundation / '.-`,_,_-_ Prop. Line ___. ... <br /> F REPAIR/ADDITION(Prev. Sanitation Permit# ________ ----------------------------------- Date -________.___t-.___________-__---I <br /> I t ', f <br /> SepticTank (Specify Requirements) ------------------- ---------------------------------------------------------------------------- ------------.,.------ -------------------- <br /> 3 Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------- ----------------------------------------------- <br /> --------------------------------------------------------------------------------Ir------------------------------------------------------------------------------------------------ ---- ------------------- <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: Horne 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 subj!04 to kman's Compensation laws of California." "h <br /> Signed --------------1---- - - ------- --------------------------------- -------------------- Owner <br /> BY ------------ --- --------- -- -- -------------------------------------------------------- Title ------------------------------------------------------------------------ <br /> (If <br /> ------------- -------------- ----------- ---------- <br /> (If of than owner) ' <br /> t r hF�OR'DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY f dY "� '� ---------- DATE 2— 1: j <br /> BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------- -------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS -------I------------------------------------------------------------------- -----------------------------------------------------------------------------•--• <br /> /AQUI <br /> ----------------------------- - <br /> 7 <br /> Final Inspection by -- ` Date - ..' SAN JN LO AL HEALTH' DISTRICT' <br /> F E. H. 9 1 P68 Rev. 5M + <br />