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FOR OFFICE USc I FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> i (Complete In Trlpllcatel Pe-mit No/T—:Y,#z/ <br /> This Permit Expires 1 Year From Dote Issued Doe <br /> Issued/O-$L•i <br /> Application is hereby mode to ?he Sam Joaquin Local Health District to: a permit to construct and 'c.stall the work here;n de;r-bed. <br /> This application is made in compliance wdh County Ordinance No. 549 and existing Rules and Regular-ons. <br /> JOB ADDRESS/LOCATION /��' ". 4;( i t- t••r.• CENSUS TRACT <br /> " <br /> Owner's Nome -) r.'.. ;....� . ... ". ._.... . . . ..., .. .. . Phone .. <br /> Address. <br /> Cay-','i' , ,;r Zip <br /> Contractor's Name I , + :,,. .. .. ... .License I. Phone . .._. <br /> Installation will serve: Residence ['J Apartment House❑ Commerelol W Trailer Court p <br /> Motel ❑ Other ... .. ' <br /> Number of living arses: Number of bedrooms Garbage Grinder .. ... . LotSize -"�:G.< .. .. . <br /> Water Supply: Public System and iome _.. .. _... .... . ..priva-six <br /> Character of soil to a depth of 9 feet: Sand 0 Silt❑ Clay 0 Peat❑ Sandy Loam❑ Clay Loam❑ <br /> Hardpan U Adobe( Fill Material If yes, type .. . .. . <br /> (Plot plan, showing size of lot, locaiton of system in relation to wells, buildings,etc.must be placed on reverse side.) O <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200(eel,) <br /> PACKAGE TREATMENT I I SEPTIC TANK I I Size .. .. _._.. . Liquid Depth ..V <br /> Capacity Type . . Material . ._. . ..No. Compartments . . .... <br /> Distance to nearest: Well .._. Foundation .. Prop. Line ..S <br /> LEACHING LINE j I No. of Lines Length of each line . .... T of Length <br /> 'D' Box Type Filter Material Depth Filter Material <br /> 0,stance,to nearest: Well Foundation Property line <br /> SEEPAGE PIT I I Depth Diameter Number . .._.. . .. Rock Filled Yes ❑ ,Nobt <br /> Water Table Depth .... . Rock Size \Nr, <br /> Distance to necuest Well Foundation Prop. Line `l <br /> REPAIR/ADDITION (Prev, rinitution Permit tT Date I <br /> Septic Tank (Specify Requaemenisl <br /> Disposal Field fSpecify Requirements) " . .. . . i��. i. r! <br /> ��� .... .. . - ,. .-, • . .. .7 , .'moi __.... . 1.-.. _. <br /> Mraw• Pxisting 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 County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> "I certify that In she performance of the work for which this permit Is Issued, t shall not employ any person in such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> r • <br /> Signed .F Owner --_-. <br /> r <br /> By ..L.. .. .. r; . . . Title <br /> J - <br /> lif Gtl,er than owner( <br /> , liR DEl0f.RTTME T USE ONLY <br /> APPLICATION ACCEPTED BV /'✓.� � �'"'^/J/r• = DATE I dl. 7P <br /> DIVISION OF LAND NUMBER /// DATE <br /> ADDITIONAL COMMENTS / '/ j <br /> Final InSaL <br /> ecion by el&/ ,4114W - Date <br /> .•• n c. SAN JOAQUIN LOCAL HEALTH DISTRICT 70 /WW 'ss tier rev r;rs sr <br />