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FOR OFFICE USE: <br /> APPLICATION FOR .SANITATION PERMIT �/�7� <br /> ! - <br /> (Complete in Triplicate) Permit No. . .... <br /> .......... --- ................................ _ q <br /> a. � <br /> This Permit Expires I Year From Date Issued y Date Issued .. .�/. <br /> IIZS`0dw-02-- <br /> Applicationsis hereby made To the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described._Th.s applicatiori,is made.in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LO ATIO ;Oclelrf�k...... ... ---u--- -- ... .J� ...CENSUS TRACT ... <br /> ., -----................. <br /> Owner's Name -.�]� �--- t Phone... .....................-•--••-... <br /> -... -- - c:_.. .... <br /> Address J`.3o X� .. ._-.... ........................... ------••--------. City t � <br /> Contractor's Ndme .-- •. .. ........License #�� ���'. .. Phone . ... -- -......--•-- <br /> Installation will serve: Residence ❑Apartment Ho e❑ Commercial❑Trailer Court ❑ <br /> - � <br /> Motel ❑Other <br /> Number of living units:_......... Number of bedrooms ...........Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply: Public System and name ................. ..............------......-- -------... . --------✓. -----..............Private M' <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑�': Clay ❑ Peat E] Sandy Loam LJ Clay Loam [] <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 /> NEW INSTALLATION: (No septic tank or seepage'pit permifted'if public`sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIiTANK1 ] Size. ..,_----- ----------------_-----............ Liquid Depth ._--___.._._._........ <br /> �^ <br /> Ca act <br /> P ty .- .....------I Type - --..........t Material No. Compartments - -_.....•....°.__-I. C <br /> Distance to]nearest: Well .__-... ....................Foundation .__.._..___. ......... Prop. Line ..........._...-_--_ <br /> LEACHING LINE ( ] No. of Lines Length of each line.___...................... Total Length ..........._....._......... 11 <br /> 'D' Box ---- Type Filter Material ....................Depth Filter Material l - <br /> Distance to nearest: Well ........................ Foundation Property Line, ......................... f <br /> SEEPAGE PIT [ J Depth ____________ _______ Diameter . ..... Number'._._..__....._............. Rock Filled Yes ❑ No 0 � <br /> }� Water Table <br /> Depth .............. ................ ................Rock Size . ....................... ----- <br /> 14 <br /> Distance to nearest: Well ......................................:Foundation ..._................ Prop. Line ...................... :� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..............................................Dole ...........-------------_-__----) <br /> r <br /> Septic Tank (Specify Requirements) .................... --------------- -- ......... - - <br /> Disposal Field (Specify Requirements) ..G>-sGt� e r�3_-�i� <br /> V_ ----------------------------- I <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 <br /> become subject to Workman's <br /> ._lC.-ovm✓p�e-'nI <br /> sa5t.i.o_Vn. laws <br /> aw-s�o'f�Cra!lti-ft. <br /> om.i.a.i}.l" <br /> Signed ----- - i -- --- - ---- .' Owner <br /> eY ---------------------.-- -- --------- <br /> (ifother <br /> S.<S.Aa�.cr�a.CTL� <br /> than owner( E - <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . ------ --------------- <br /> ........................__-_--- DATE .3.':3O"7.l.__------------ <br /> -- ---- - <br /> BUILDINGPERMIT ISSUED ................................... ................................._----------------- .............-DATE ............................ .............. <br /> ADDITIONALCOMMENTS ---------------- ................ ............................._..........------............................ ..... <br /> ......................... <br /> -------- -- ----- r--- -- ---- -------------- ................................ -------- ---­----------- ......................... ... :...._ ....... <br /> ..............I............................................ <br /> ....•..... -....... ------------ -- -----------------•-••-•----...------.---------------------------.-.-.------------------------------•---------------------- <br /> Final Inspection by: 2t..---�-- ... .... ........ ..................Date ......_----............... <br /> -- ---- <br /> ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />