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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> d <br /> (Complete in Triplicate) <br /> ..................................... .. <br /> c Date Issued <br />_•„_••-•,,,„ ,,,,„ ,,,,,, This Permit-Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work therein <br /> described, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> _ � 1 ! <br /> JOB ADDRESS/LOCATION �.. ............CENSUS TRACT � <br /> Ower—Is ggL .................................................. <br /> L. .'(........Phone <br /> Address - .l.-.....:./ 1 . ' / ?' ........................... City .. �r� `� ................. ...... ... . ' <br /> `.. <br /> ._• <br /> Cantractor.'s-'Name-.-.:-, i -= 1 /"”: _.._......_.License # s�L�/, .t". Phone ff_�-�,±A�' <br /> Instailotion will serve: Residence-Qg-Apartment House•[j Commercial QTrailer Court j] <br /> Motel:❑Other <br /> - . <br /> ------------------------- ----------- <br /> Number o' '(vin units:.__� Num er_a .___Garboga Grinder Lot� . Lot Size � L <br /> ��'e_ <br /> WaeSupply:.Public System �`.'. <br /> <:._... . <br /> and'name' ei] ; <br /> -----•................ . <br /> daracter of soll to a depth of 3 feet: Sand 0 Silt❑ Clay.❑ LPeat❑ Sandy Lobm ❑ . Clay Loam ] ' <br /> i e i :.. _------------------- <br /> Hardpan ❑ Adobe Fill Mat r'ai If yes,;type ' <br /> ' y <br /> (Pot pla.n,, showing size of lot, .iocation_.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 sewer is available within 200,feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK f ] Sixe______...........____ ____ ___________________ Liquid Depth .._ -- -_-- •- <br /> ....; <br /> Capacity ------.__-__.-Type ----- . --- Material----------............. No.. Compartments . ... <br /> Distance to nearest: Well __Foundation. Prop Line'...................... <br /> LEACHING LINE ) ] No. of Linesg g •, <br /> __:. Length of each line...........:. _.. Total Length ___..:........ ' <br /> ` 'D' Box ........----- Type Filter Material --„:...............Depth Filter Maferial` :'-- ?"_:"'................ <br /> Distance to; nearest: Well ...: Foundation ............: ........... Property Line, '°• <br /> SEEPAGE.PIT Depth ...:.. _ Diameter :............... Number ........-..... Rock Filled Yes No•. <br /> Water Table Depth ................................... ..Rock Size .............................. .,...,.. <br /> : Distance to nearest: Well .... ............:......................Foundation .................... Prop. Line ` -- --__-_ <br /> ......... <br /> R&PAIR/ADDITION JPrev. Sanitation�Permit# .... ................... Date ................ .. ) <br /> !Septic Tank '(Specify .Requirements) ................. ..... .... . ..........:.......___. __ ......... .. ............. t <br /> Disposal' Field (Specify Requirements) -- . I. --f� e/_.__ --J--- 11 ...E _` ._. ...... <br /> 3 <br /> (Draw existing and required addition on reverse side) <br /> I l ereby certify that I have prepared this application and that the work Will be done'.in accordance with:San!: Joaquin <br /> Couhty-Ordinaisces; State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owirfer oar"1iceri�' <br /> sed agents,signature certifies the following: 3 <br /> °"1�cerfity that in the performance of the"work for which this permit is issued, l shall not employ any person in.such manner, <br />'. as'to becorise subject to Workman's:Coinpensation laws of California," <br /> Si fined ------------ ...-:..... - Owner <br /> . .... <br /> (If other an owner) <br /> F FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE <br /> BUILDING r PERMIT ISSUED ......•--=---=---•------•=--- -•--_----= :.. :::.._.:DATE .............:.••--. .......... <br /> -ADDITIONAL COMMENTS ...............:............:.............•................................. ..._. .............-............:...................................----............ <br /> 5. .••---....---------------------„-.,-._....--•••....... ' _._.._......................_...._ ..... ..-. :--. .. ----•--- ..--- . =- <br /> t....-_...-=-------------------------------- ---- . -•--•- --- ..,.----- - ..----•-- . ----... - <br /> :.. -------- -- --------- ...................... .......... - <br /> Final Ins ectEon b Date ... <br /> P Y - - . <br /> USAN JOAQUIN LOCAL HEALTH DISTRICT <br />