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FOR OFFICE USE: -;7 <br /> PLICATION FOR SANITATION PERF <br /> (Complete in Triplicate) Permit No. 1 C <br /> This Permit Expires 1 Year From Date Issued Date Issued . _. a7 <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 <br /> No. 549 and existing Rules and Regulations: <br /> w `! '' `.' <br /> - JOB ADDRESS/LOCAT�I/ON .._l _f5 9_.. :_..L.I1 'c���--- -- -�?--.-.-. --.D.�-------- - -----CENSUS TRACT ------------ ...... <br /> Owner's Name ....f��—.5-le G 7d_�l�(------•-••----------------------------- ----------.Phone <br /> Address --- X 1'4 fXI !�----------------- Cit <br /> Contractor's Name --------`ye_/t;.. - ------------------------------------------•- -------------_License # ---- - ------_--- Phone --------------- .............. <br /> Installation will serve: Residence [2"A'partment House❑ Commercial ❑Trailer Court fl <br /> - Motel ❑ Other -- -- ----------------- -- -------- (n <br /> Number of living units:.... ------ Number of bedrooms _--------Garbage Grinder ------- _ . Lot Size ._ G_� X <br /> V <br /> Water Supply: Public System and name -------- ------ ----------- ----------_--- -------------------------_.Private [ � <br /> _ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Q/ 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 permitted if public sewer is available within 200 feet,) <br /> I <br /> PACKAGE TREATMENT [ ] SEPTIC TANK jvj/ S' e------------------------------------------------ Liquid Depth ------ ----•----•---- <br /> Capacity -------- Type f` ------- MaterialNo. Compartments -_33—.............. ` <br /> Distance to nearest: Well ..4 - __._-______-___-----_Foundation •-----Q--.___- Prop. Line ___ ---•__-___---. <br /> LEACHING LINE [L}/o. of Lines .__G. .____--_ Length of each line._._.2.:,>................ Total Length ---/ V`-_-__._-.__. <br /> 'D' Box . %__. Type Filter MaterialDe p <br /> th Filter Materia! .....I5............ ............•-.-._-_-- <br /> Distance to nearest: Weii ----- ----------- Foundation _: ------------------ f <br /> .__-- rrvperry I.IrIC __�................... � <br /> SEEPAGE PIT (� Depth Diameter Number _ -------X ./-----. Rock Filled Yes Q--- No Ci <br /> - <br /> Water Table Depth -----------------------------•----- ---..Rock Size -------.....---- --------------- <br /> I Distance to nearest: Well __/404?f, ........­ <br /> ----------- --- -----Foundation <br /> -• ! Prop. Line ` <br /> REPAIR/ADDITION(Pr9v. Sanitation Permit# ------- ------------------------------------ Date ----__-•-_-_-___________-------1 <br /> Septic Tank (Specify Requirements) --- ----------- ------------------------------•------------ - ------ <br /> Disposal <br /> ----Disposal Field (Specify Requirements) ---------- ------- -------------------------------------- --- -------- -- -------------------- - <br /> --------- ------------ ----- --_ - ----------------- ----------•••-•-- ---------------------------------------------------- --- <br /> - -------------•-------------------•----------------•--- ----------------•-------••-------•----------------------------------- <br /> (Draw existing and 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' Compensation laws of California." <br /> �k- /6 Signed ._ �. - -------- ---- Owner <br /> BY - - -------- -- Title _ ----- ---------- -- -- ------------ - - -------- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> DATE --- <br /> APPLICATION ACCEPTED BY -------- --- ------ -'----.• ------------------------- --- <br /> •----•--- <br /> BUILDINGPERMIT ISSUED ----------•---•-------•------- -----------------------------------------DATE -----•------•---•-----•-•------•-•-------- <br /> ADDITIONALCOMMENTS -•-------------------- -•------•--•-----.. ........................... .............. <br /> -----­-------------------- <br /> ------ ---------••------------------------------•--•--------- ---•-------•-------------••----•---•-----•......•---•--------------------••------••-. •_.. <br /> --- <br /> - <br /> f - <br /> ------ ---------•------------•-•----••---------------•------ - <br /> --------•---- ----- --•----- _ <br /> -•-------- • ---•----•-••-----•--•---•- <br /> 7 <br /> - -• . -•--------- D Date Inspection by: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />