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FOR OFFICE USE: -)PLICATION FOR SANITATION PER ? <br /> � Permit No. __�`.3.--�d <br /> -- - -- --- (Complete inTriplicate <br /> ....-.. - -- --.... ,�,,,( <br /> ...................... This Permit Expires 1 Year From Datelsssj� t ,(`�fte Issued <br /> .. ..�...... . <br /> Application is hereby made to the San Joaquin Local Health District fora permit to constructandand 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 ......L..ILL_I--...-.: '.......... ........__ .....CENSUS TRACT -.--_---•/- --------- <br /> Owner's Name ....-. _ �: .............Phone . <br /> _ av �� l : . _ )_ <br /> Address _ -�V� Y/..... k...Oaf.-.-�....:...... ...... --............................... City f..� .j) - <br /> Contractor's Name .-.....--• ----------.... ..............•----------. - ..._License # --------- -------_---- Phone .................. <br /> ......_..... <br /> Installation will serve: Residence❑Apartment House Q Commercial ❑Traller Court O <br /> Motel)]Other ............... ............................ <br /> Number of living units:.,--1.-__ Number of bedrooms- :?..-.--Garbage Grindery `�.. Lot Size .-_ ._��.1 r:-- -------• <br /> Water Supply: Public System and name ......... ........ - .......--- ............._...... ------ ......----......•.......... ... ..Private B- <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Q <br /> Hardpan ❑ Adobe ❑ 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 /> N. <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,]///S, "t <br /> PACKAGE TREATMENT ( J SEPTIC TANK VJ Size.... X.��.-x---".'------------------ Liquid Depth ...1..`..,................. \ <br /> p tY YPe )� fit,i'Ile <br /> Ca aci �� L �. i.-. T 1/>.L ��l.a.!.. Material.. .....�rNo. Compartments ..................... <br /> - / <br /> Distance to neoresii�-Well ........ ........ ................Foundation ..J(.............. Prop. Line ..... ......._-._. <br /> LEACHING LINE P J No. of Lines _-. '::-----.----. Length of each line.........- --_ ...... <br /> Total Length ..... 1 _.�...-.-. <br /> 'D' Boxy/T:.:_ Type Filter Material _Ij : .{ ....Depth Filter Material ........L;�............:.............. <br /> Distance to nearest: Well .....'�...r.z__.--- Foundation . . ....:----._-- Property Line ....`.?........a <br /> SEEPAGE PIT (• ) Depth ../_ ........... Diameter i'_:!...,.e--.. Number __.- . -:.--._ ------ Rock Filled Yes a-- No r❑ <br /> Water Table Depth ............. ' - ............. . -----Rock Size ----------- -------:.::.=.- <br /> Distance to nearest: Well ......fe."..........................Foundation --./ ..... Prop. Line ..-- ?.._. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I <br /> SepticTank (Specify Requirements) ................................-------.... ......-.............................. ......................._............----------......... <br /> Disposal Field (Specify Requirements) ................. .............. <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 Son 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 becomesubject to Workman's Compensation laws of California." <br /> Signed .;:'. /:(- ..:._.--. .::.:....-:----------------------------------------------.- Owner <br /> By .......----------_-...---------I---------------- --------------­.... - ... _ Title .- .. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... J .t.I.C.: ----------------------------------------- ................................... DATE .....::':..:.-_ .:...'......C... ... <br /> BUILDINGPERMIT ISSUED ....................................... ------------------------------- ...........__...............DATE .......... .......................... <br /> ADDITIONAL COMMENTS - . ..... r <br /> .... ..... ----------------_-- - . ... ...... ..... � ^'. - -._.._._.............I.. ...................-- .......I------- -- ... - <br /> 0:0 <br /> ......--... .. <br /> -- - - - - ....-.... -- -- -- --- ............................... ... ..... . .. .. ... <br /> _-. ... <br /> - - - ... . .. .... .... - - -- <br /> . . ............. 5- <br /> .- <br /> Final Inspection - -. ...- .- ....- -. ....:......................Date .... -. ...-. .-- <br /> SAN JOAQUIN L L HEALTH DISTRICTg <br />