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FOR OFFICE USE: <br /> ............ - <br /> ............. --•---.-• --... ..._......... <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit Na. -..Y.�........ <br /> ....... This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made tZai.de <br /> e �iomplionce <br /> quin Local Health District for a permit to construct and install the work herein <br /> described�Thjs �p ication ' with County Ordinance No. 549 and existing Rules and Regulations. <br />{ JOB ADDRESS/LOCAT �r°�.�....- � ,'e.� .T 4, CENSUS TRACY <br /> ...-- - --- ------ -- . ------------ ...........•. <br /> Owner's Nam .......Phone .................................... <br /> Address ...._ ..: .. :i .. o6..-7 . Cit - _ <br /> Contractor's Name ---a�-,�uv - �,,- c ��S--- -"`...License # . .... .9.... Phone .............................. <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ] <br /> Motel ❑Other ... IS <br /> '-it-�o <br /> Number of living units:..- Number of bedrooms .77^._Garbage Grinder ....tr--dot Size ............. . <br /> Water Supply: Public System and name .._.............____........ Private <br /> ------•. .............•-----.__...........---•......................... <br /> Character of soil to a depth of 3 feet: !Sand❑ Silt❑ Clay F] Peat E] Sandy Loam ❑ Q Clay Loam ❑'� <br /> Hardpan ❑ Adobe 0 Fill Material ..--------- if yes, type V ' <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; (A r + <br /> I <br /> {No septic tank or seepage pit permitted if�ublie sewer is available within 200 feet,) f <br /> PACKAGE TREATMENT SEPTIC TANK[ ) Size. - -._--- Liquid Depth .... ................. <br /> _- - <br /> C - Capacity .�i ��_ .. Type 01,44--.cf'r..._._. Material... No. Compartments r <br /> Distance to nearest: Well _ ......-----------------Foundotion .../-d1.._......._ Prop. Line __ •_. . <br /> LEACHING LINE [PI No. of Lines - <br /> ._ _.. .__.. Length of each line ....:.....jrd.__�..,....- Total Length ... -�.�................. <br /> 'D' Box .... Type Filter Material --------------------Depth Filter Material ................................. <br /> .......... <br /> Distance to nearest: Well -------- --------------- -Foundation ---__------------ ---- Property Line .. <br /> SEEPAGE PIT Depth .j. ---------- Diameter Number . ......................... Rock Filled Yes ❑ No (] <br /> Water Table Depth-=------------ ---------------------------------Rock Size <br /> Distance to nearest: We'll ...................._---.-__------.--Foundation ...._....... ....... Prop. Line ................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit .-.--_-->._..........•_:_- .... Date -------.----•------- .----I <br /> .��. r_ v_ <br /> Septic Tank (Specify Requirements) - ------------- ..........._.1......=-------------- <br /> Disposdl /Field (specify Requirements]" F -------------------------------------------------------------- -- <br /> .-.-.-...._.....-..----.....--------------------•-------- <br /> ............... <br /> - <br /> .................. <br /> (Draw existing and required addition on reverse side) <br /> A ..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 /> sed agents signature certifies the following: <br /> "1 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' Compensation laws of California. i <br /> Signed .:...... ----.- Owner Title .�-�� � <br /> lif other than owner) ........ .......I........................ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .-.. . ----- ... ... ............ ....... ........ DATE __.. ... ......-7. .._.......--• <br /> BUILDING PERMIT ISSUED ...............#... . --------------- .................. _.._....... ..DATE ..... ..................................... <br /> ADDITIONAL COMMENTS .................................. <br /> ..................... .............. ........ ---------­­ •--•--...-- --......__...........---...------ --------_... ........ ..... .................................. <br /> ---- _ <br /> FinalInspection by: .. .. 2 ...-•.......... ......................Date ............. <br /> Final <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> SS <br /> 1.3 24 1_'&, Rav RAA <br />