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FOR OFFICE USE: <br /> `,,PPLICATION FOR SANITATION PE.,_,iT <br /> (Complete in Triplicate) Permit No. ._Z-_..-.... .... <br /> ------­­- .�. 7c/ <br /> -...--..... <br /> _-__-_.........._._...._.._...._.-......... This Permit Expires 1 Year From Date Issued Date Issued ..... <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 ........- f -Z � ^� CENSUS TRACT ...... ........ ... ..... <br /> Owner's Name ------------------------ --------------------------------Phone ................................... <br /> C <br /> .� Address _ _ ....._��}� -. .. _`�...... �P.41�2?3... ........-- •---- --------•--. City -LL-�f.�-- .-. ..---------------------------------- <br /> 40 <br /> ......... . ....... .........-- <br /> Contractor's Name ._... r c �.aJ-- ----- ---- ----.c.... .................License # �P A-y---- Phone .............................. <br /> Installation will serve: Residence Apartment House C] Commercial oTrailer Court 0 <br /> Motel ❑Other - -- ......... -. . ............._--.. <br /> Number of living units:___ _- Number of bedrooms ...2.'�--Garbage Grinder ----- ------ lot Size ------ ........� <br /> .. Water Supply: Public System and name ----------------- ......—---_----- -----......------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand j] 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 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 I I Size------------------------------------------------ Liquid Depth .-........................ <br /> Capacity .....- . --- Type .................... Material---- -------------- No. Compartments . . ................ \ <br /> Distance to nearest: Well ....................................Foundation -..------------------- Prop. Line ................_ - <br /> LEACHING LINE [ j No, of Lines _.-------------------- Length of each line -------------- .-... Total Length ............................ <br /> 'D' Box .... Type Filter Material ....................Depth Filter Material ----------------------- --------- ---.------ <br /> Distance to nearest: Well ---- -------- --------.. Foundation ------------------------ Property Line ......._.............. <br /> . <br /> SEEPAGE PIT [ j Depth ._--- -----------_ Diameter ..-------....... Number _ ------------------_----- Rock Filled Yes [] No Q <br /> Water Table Depth ........................................... .-.Rock Size ......................... ----- <br /> Distance to nearest: Well ............. ..........................Foundation ..---.......-------- Prop. Line ..........-----...-... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .....-.......................-..-.) <br /> Septic Tank (Specify Requirements) . .-... �y'...- ---------------------------- <br /> Disposal <br /> -- ---------------- <br /> Disposal Field (Specify Requirements ------------------------------- <br /> " Vie _. C. P, s. ��zL' 7--. -- --- <br /> - .3 3 - ... --------------------------------------- ....-..------------..------------ - <br /> (Draw existing dhd required addition on reverse side) <br /> 1 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 /> "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 Co ensation laws of California." <br /> Signed ... .... __-- - - -- Owner <br /> By -._ .. . <br /> (If other than owner <br /> FOR DEPARTMENT USE 9NLY <br /> APPLICATION ACCEPTED BY ........ . .. . ------ .. _ -------- <br /> _..... - .....---..-_ DATE . . -_.-. .....7............... <br /> BUILDING PERMIT ISSUED ---------------------------------- --- -------- .... DATE . ....................... ..... ..... <br /> ADDITIONALCOMMENTS . - ....... .. ............... . ............ . -----------_..._...--..--......--.........--.... --.._............... . .....--------------- <br /> .... . ._...-._...... . - - .........- ------------- ----------- -------........................... ....... ------ ......................................----- -----............. <br /> .. _ �..---- <br /> ....- ----- <br /> ---- - <br /> --------------------------- .....- _ <br /> --r <br /> Final Inspection by: ....-..- ----- .... ... ... ... ........................--Date .- -✓- -- ---._.(----,-...... <br /> �-. . . <br /> SAN JOAQU LOCAL HEALTH DISTRICT <br />