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I FOR OFFICE USE: <br /> .... . .............. <br /> APPLICATION FOR SANITATION PI;Rrvti1T <br /> .. -- •.• (Complete in Triplicate) Permit No. -.-75..._.. <br /> .. .............................. <br /> .... This Permit Expires 1 Yeaf From Date Issued Date Issued .. r :-? � <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 ...,)-C-6'. --. t <br /> L� <br /> - ........................ ...... ..CENSUS TRACT <br /> Owner's Name ..... . :_....-...•--..._. .. <br /> rte, ._.._ one ........................ ... <br /> Address I-..-_ . / City ................................ <br /> Contractor's Name . <br /> ........................ <br /> .._....._ ­------------------------- <br /> ..License# ....... . ............ Phone --......._..-......__.._. .. . <br /> Installation will serve: Residence Apartment House Commercial Trailer Court a <br /> I Motel M Other,.......... <br /> ....... ..._ . _ ..-------------- <br /> Number of living units:..... .---_. Number of bedrooms -_--..-.___-Garbage Grinder ....... Lot Size - ______________ <br /> Water Supply: Public System and name .......................... ... _...................... <br /> l _ .___............................................ .......Private <br /> Character of soil to a depth of 3 feet: Sand 0 Clay ❑ Peat jD Sandy Loam ❑ Clay Loam ❑ <br /> E Hardpan ❑ Adobe 0 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet.} <br /> PACKAGE TREATMENT SEPTIC TANK _-__-- Liquid Depth .......................... <br /> [ I Size.---•---•--•-----------• -------••--• •-•- <br /> Capacity -_- -----..... Type .................... Material---------------------- No. Compartments <br /> Distance to nearest: Well ....................................Foundation ._...._....-......-_-- Prop. tine ................. <br /> LEACHING LINE [ ] 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 /> SEEPAGE PIT [ } Depth _. .. .........-.... Diameter ................ Number Rock Filled Yes ❑ No ❑ ,� <br /> Water Table Depth ......................... <br /> ----------- ------•.Rock Size ....----....---..__._._.. - ._ <br /> Distance to nearest: Well .................................. . Foundation .................... Prop. Line ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit ....___.----•-. <br /> -------- --- ------ Date ---------------•----- ) <br /> Septic Tank (Specify Requirements) .-•.........:......_.._.-...._._._ .. _ <br /> Disposal Field (Specify Requirements) _____________Y>`�••f -•__ �-! {� i 5 Sup.r <br /> ...---....d-• -- <br /> --- <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 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 toWorkman's Compensation laws of California." <br /> .__.,:. <br /> is <br /> Signed Owner <br /> By r H t� Title <br /> a. ...... ...-_. <br /> (if other than owner)�i FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> BUILDING PERMIT ISSUED ......... .................... <br /> -------------------------------------------------- ._._-..--- <br /> -_. DATE <br /> { ........... --------- <br /> i <br /> -- . _ - ................ ........................... DATr _ADDITIONAL COMMENTS ____.._y •• .r i <br /> --- . . . <br /> ................._..._...-..............._. _....___.. _.-.......-_..-.---....-----.._..--•--........... .._.--- ...---.._... ......__._....-....._-...-..-._....----...--..-----•------ ........._ <br /> . A <br /> y.._._:....-.. -••---•-------•----...-•................•--....--•--...._...------•---•--•--._-...---•-....._....-- ....---... <br /> Final Inspection by: :::-._...:_' ..__.._.... .............. <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 7 1-F�•s <br />