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FOR OFFICE USE: <br /> APPLICATION-FOR SANITATION P5RMiT <br /> ..............__ .................................. 7�-7�7 <br /> (Complete in Triplicate) <br /> Permit No. ..................... <br />.............. .................................... ...... <br />...................................................•_.... This Permit Expires 1 Year From Dale Issued <br /> Date Issued ........'.b <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 with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ' CENSUS TRAGI .:............. <br /> ........ .-•-•••---•- ... -'•........................... <br /> Owner's Name ... Cqfrl /._._..li �T..G�.Py rte............ •-• <br /> Address ...................... -_:_____._.. ............... ..... Cit ............................. <br /> Y -- ••-•------•-••--•--- •..._....- <br /> Contractor's Name .............c = ............License # ...--•---:...._...---•-- Phone ........................ <br /> ._..... <br /> Installation will serve: Residence �tment House 0 Commercial OTrailer Court O <br /> -- Motel ❑Other ------ ---------•---•--•---•--------------_ <br /> Number of living units-----/..... .Number of bedrooms _____Garbage Grinder ............ Lot Size ............................................ <br /> WatIr Supply, Public System and name .......: --------------------- .........•------------------- ------ ---------__.---------------------.Private �.. <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type --_---_-----_- <br /> (Plot <br /> ................(Plot plan, showing size of lot, location ofsystem in .relation to wells, buildings, etc. muit•'be placed on reverse side.) <br /> I <br /> NEW.INSTALLATION: (No septic tank or seeps e,.pit permitted if public sewer is available within 200 feet,) <br /> f <br /> PA&AGE TREATMENT [ ) SEPTIC TANK4 ;41, Size............................................ ... I°Liquid Depth ....._..._. ............. 1 <br /> > {_, r <br /> Capacity /400 Tye <br /> ..•- <br /> p ._ Material :-- No.1 Compartments .�............... <br /> Distance to nearest: Well COe_____________________•____Foundation _.ld� _________. Prop. Line •_-----___-_---_•_•-_-J" <br /> iilkie tip No. of Lines A........... Length of each line- Notal Length ._.p <br /> D' Bax Type Filter Material . epth Filter- Material .._ _y.....................•--••_-•----..f <br /> Distance to nearest: Well _._4t_?'._.•____._•.. Foundation .......Ili .._....... Property Line ......................... <br /> N <br /> SEEPAGE PIT [ j Depth ------------- —Diameter -•--------.=-Number .. _;___ --•-- - Rock Filled Yes ❑ No ❑ A) <br /> Water Table D th ..:...�"�.: -,•:_:::�;.'. :=...::'.Rock Size .. ................ . <br /> Distance to nearest:.Well ........................................Foundations....1.............. Prop. Line ____.--.__...----_-_--. <br /> REPAIR/ADDITION(Prev. Sanitation Permit�#............-._ `• ....ti►�___....Date __ ..._ ................y <br /> ��fSeptic Tank (Specify Requirements) .. ... ......._.. ...................................... ............. 9 <br /> Disposal Field (Specify Requirements( ._.....--_.............. .....................-................. ----- .......-------._._._.__..__.______.__._..._........ <br /> ._.. <br /> ..........._-_--••:.......................... <br /> ---------- ----- _...-----•--..-_..- <br /> (Dtaw existmg 'arid 4`4`q' addition on reverse std ) u4` <br /> I herby certify that I havelprepared this application and that the work will-bbidone in accordance with San. Joaquin <br /> County Ordinances, State Laws, and Rules.and-.Regul,ations.o-f the San Joaqui;4cal-ihealth District. Home owner of licen- <br /> sed agents signature certifie}the foliowing: It <br /> °'I certify that in ehe performance-of-th work-for which this permit is issued, I shall employ any person in such manner <br /> as tobeeome sub eet Workma 'srpen�, n of California." �' <br /> M <br /> Signed ---..z..._._.,Ow.nec��� <br /> BY ....I-------- ......................... - Title <br /> ..................................... <br /> f other than owner) ► t <br /> FOR DEPARTMENT USE, ONLY <br /> APPLICATION-ACCEPTED-BY--. .... <br /> : ±.-­—,—.7.—... ....--.---._ - -•. - DATE <br /> BUILDING PERMIT ISSUED -•--------•-- DA -:-... <br /> . <br /> ADDITIONAL COMMENTS --------- <br /> '.._:. <br /> ----------• ---------•----- --•----•:...............•. ............................................................. <br /> ---------------------------------••---••---•... :.:__:.. ........................................-••-••-•.........--•-=------------...---_._....-•-----•-•---•-•-- •--••------- -•-••--•-•-.._.. -----•-- ......••......­­.. <br /> ........... <br /> f <br /> FiKai inspection by: ...-----••-_ ate ... .. .~5...__.'Zk.__.__... 1 <br /> --- <br /> �. _. SAN,JOAQUIN :`iOCAL HEALTH DISTRICT _ <br /> c u 13 24 <br />