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-FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No: _��----__---- � <br /> ---------------------- <br /> ----------•--------------------- (Complete in Triplicate) <br /> Date issued l.._--__ .-`---•r-,. <br /> This Permit Expires 1 Year From ate slue <br /> e work..herein", <br /> de to the San Joaquin Local Health District fora Nor. 549 and ex sto ctti and <br /> nR lestalndhRegulat ons: <br /> Application is hereby ma . <br /> described. This application is ma in compliance ith County Or i nce <br /> r04- �------------ <br /> L SIlS TRACT _,5: �------- <br /> JOB ADDRESS/LOCA N,.- -- r ------------------Phone <br /> -------- ------ <br /> Owner's Name ------ ---- -----�' -:_ - ---- -------- <br /> City__ - <br /> Address ---------------'""3 "' -_-; ^/-�- <br /> 00 �� - - Phone - ------ <br /> --------------- <br /> ---.License #�- --�- - --- - <br /> Contractor shame ............' <br /> ----------- -- ----- -- <br /> Installation will serve: Residence Apartment House-[DCommercial []Trailer Court , <br /> Motel ❑Other -------------•----------------------- fj <br /> _-.Lot Size- ---------- <br /> ------- <br /> Number of living units:___--�---- Number-of bedrooms "-/-=Garbage° n er --,--= <br /> ' --_-Private [] <br /> Character of soil to a depth of 3 feefi:s Sand Cl " <br /> Peat Sandy Loam ❑ Clay'Loam '[] <br /> Water Supply: Public Syste� an name ------------------------------------ <br /> C <br /> Q Silt❑ Clay ❑ ❑ <br /> o Hardpan❑ Adobe <br /> Fill Material - ----- -r=-�- If�.yes,type ---------------- ------ -=i- � ....- rled„ <br /> ” R ,t <br /> buildings, etc. must be placed onreverse side.) <br /> i (Plot plan, showing size of lot, location. of system in ream YFed if public"sewer,iy a a;labl`4/ithin 200 feet,) „ <br /> i NEW INSTALLATION iNo 'septic tank or seepage p p _ "' s' <br /> "�,V> -XS_1---------------- -- Liquid Depth --- <br /> S• a--�--- -=------- ---- �.. <br /> I PACKAGE TREATMENT [ ] SEPTIC TANK I /' I k _-- <br /> �i U -'--- No. Compartments <br /> I <br /> Capacity/Da Type <br /> Foundation <br /> Distance to nearest: W611 -------- ---- ------ -- -----F ,----1_Q----'--- - Prop. Line _ <br /> 1 l ' ` Total Length -_l�Q------------- <br /> i1 _---- Length of each line------- <br /> LEACHING LINE No. of Lines ------- n �, �/� a `�----- •--- ------•.--•- <br /> D' Box __---t/TYPe Filter Material _ -_-�` ----Depth Filter Material -----f-21----- ! <br /> I' _I Property Line -__> ----------- <br /> t .. . <br /> Foundation ----�-- ------- -- � . <br /> Distance to nea'"re"st�We11 ------------- �- No i❑ <br /> r <br /> Number--- -- Y' -Rock Filled Yes <br /> 1 Diameter - 3- ri <br /> Dept --- -� --------- rr <br /> I SEEP �Q P I Y_- <br /> Water. Table `Depth --- ---------- <br /> ----------------Rock Size -x- --- -- �- - -- f <br /> i I � - -1 .� <br /> Distance to nearest: V ----------------- <br /> --- - - ------------Foundation�;_: _-� --�'-"--_-)prop. Line -- <br /> � P <br /> 1 t ------ <br /> ------------------ Date ---------------- ={- <br /> REPAIR/ADDITION(Prev. Sanitation Per _----- - ----------- <br /> q --------------------------------------------------------------------- <br /> eptic Tank (Specify Requirments) ----------------------- <br /> ------------------------------------------- <br /> Disposal Field (Specify Requ.i.rementsl_--v. ----------•- <br /> ' ---- - <br /> ----------- --- ---=-- <br /> (Draw existing and requi _ <br /> ------- <br /> ------------------ -- -- <br /> ------------------------------"---"-- 'red addition on reverse-s;del <br /> I hereby certify that I have prepared this applI. ication and that the workjwill'be doneJn accordance with San Joaquin <br /> County 'Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local }feallh. strict. Home owner or licen- ¢ <br /> Co y 1 <br /> sed agents signature certifies the following: arson in such ntenner <br /> s certify that in the performance of the work for which this permit is issued, I shall not employ any p <br /> as to become subject to Workman's Compensation laws of California." <br /> -- - -- --------- <br /> Owner <br /> Signed ----- ------------------------------ <br /> -------------- ---------- <br /> -- - -- -------- <br /> {If other tha wner) <br /> FOR DEPARTMENT USE ONLY <br /> '- -1-- -------------------------- -------------- - <br /> DATE - <br /> APPLICATION ACCEPTED t3 --------------------------------- <br /> Y _- ---- DATE ------ ----------------------------------- <br /> BUILDING PERMIT )SSU ----- ----- ---- - - - <br /> ADDITIONAL COMMENTS-- -------- -- -------------------- --- -- ---------------------------- --- <br /> -, <br /> - <br /> -------- <br /> 2 41 <br /> ---------- - ------------------ -- Date � --------------------------------- <br /> -------------------------- - T <br /> 1� <br /> Final Inspection by: __-- --=- --- -- - -`- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I � <br /> E. H. 9 1-'68 Rev: 5M - <br />