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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT !/ <br />........ ............................... Permit-No. .. -T.:.��� <br /> ........... ..... ...._......._........-........-.. (Cam late in Tri ! <br /> Triplicate) <br /> • This Permit Expires i Year F Date Issued ...�`.�...�� <br />................ ..-......._... - ._._... p From Date hued <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 ..... ....... -------R_J.05Q................................ ...... :... . :.. <br /> CENSUS TRACT .... <br /> Owner's Name ..1/....... <br /> --�t••• a��+ Phone <br /> ....... <br /> . 'Address .... ........................... ......................•- _ ---........ city .............._..-•--•-•--•-_.... .. ...._................ <br /> -� _...License PhoneContractor's Name S .� - � <br /> Installation . <br /> will:se' Residence .Aportrnent Wouse�❑,Commercipl,oT_railer.rCourt,0 <br /> Motel ❑Other ............................................ <br /> Number of Irving units:..�J..... Number of bedrooms J. ...... Grinder ............ Lot Size ............. <br /> Water Su pplyi-Pu bl ic-Sy stem andncime ........................_......................................................................................Private <br /> Character of soil to a depth of 3 feet: Sandg .Silt❑ Clay ❑ ' Pe.at❑ Sandy Loam 0 Clay Loam ❑ <br /> Hardpan ❑ Adobe ,E] Fill Material ...... ..... If 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 INSTALLATIONc "(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK,S4 Size...f.;, .,�5 _.�1;.�............. Liquid Depth ....'�^ ...._......... . <br /> Capacity D. . TypeMateriaY4rNo. Compartments <br /> Distance to nearest: Well �,1'�d _._.. Foundation _40............ Prop. Line ._.3...'........ <br /> LEACHING LINE No. of Lines ::.,`Z............... Length of each'line../i 0.._..._..._..--- Total Length _ �...... ...'........ <br /> Type Filter Material ,,�'.aL1n_ Depth Filter Material I� <br /> D' Box yp p �. ..... .............. <br /> to nearest: Weil .....,i�T-_..._...•... Foundation ./O�. ............ Property Line .. '............... <br /> SEEPAGE PIT [ 7 Depth ............ Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ....Rock Size <br /> Distance to nearest: Well................... .. :..__,.»..Foundation .................... Prop. Line � <br /> REPAIR/ADDITION(Prev. Sanitation' Permit# .......................... ................ Date ................................ <br /> 1 <br /> Septic Tank (Specify Requirements) ------ - ----- -----•---.-:.........:_................._-_..:.............................._......_....-------••••.. <br /> Disposal Field (Specify Requirements) ------•--------•-••-•........................•. <br /> ........................................................ <br /> .................-.............................................-........-...................-................ . <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. home owner or licen. <br /> I 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 subject to Workman's.Compensation laws of California." <br /> Signed ................................. ....................•-••--•-•._........_.. Owner <br /> By ................... .._ , title .° -��.���C.__. .......:..... <br /> (if other t an ow .. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. DATE ... ......... <br /> _.._........ ......................., <br /> BUILDINGPERMIT ISSUED ........._..•......:....................'..............••----._...................---- ............. DATE --•••-•...._............---•=--••.. ........ <br /> ADDITIONALCOMMENTS ...........................................................I................ ...........................................................,........ ............. <br /> ......................... ' ----------------:----.•-•-.-..-..•••--••-•-•-••-•--............_....• .......... .. ........__...•..........._._......... <br /> ... a <br /> Final Inspection by: ...:.. ... t . <br /> �' .. <br /> SAN JOAQUIN -LOCAL HEALTH DISTRICT <br /> f, <br /> 13 24 7/723 M <br /> + E. H. 1- 68 Rev. 5M ___ <br />