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FOR OFFICE USE: <br /> F APPLICATION FOR SANITATION PERMIT <br /> ........................ Y- � Permit No. ._.��° <br /> f/�! { IComplete In Tripiieatel...-. <br /> _... <br /> This Permit Expires t Year From Date Issued Dateii;i'Isiued ./. ..,i: .k� <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 /> r <br /> JOB ADDRESS/LOC TO ' .�.... _._.. ,c.r�.. . ................._..CENSUS TRACT .......................... <br /> Owner's Name ... �f -- llGl...WAddress <br /> . ..... .......................•- .....................Phone .................................r c7..-....-•----------•_.--./.-,/..3,2_... J-..... . .•+� , /..........:City , <br /> ,,��"" .--- . ..•...............•-•--...-•...................... ..................... <br /> Contractor's Name .....1K J-1 .... ,r+- :------A. .9A . 15. ...........License 9lk a.7� �._._ Phone ,t1�.A4. _ _61 <br /> Installation will serve: Residencer <br /> 0-9p-a'rorment House fl Commercial❑frailer Court � <br /> Motel ❑Other....................:..............:........ <br /> / <br /> Number of living units:-- Number of oo s _......Garbage Grinderp..... Lot Size-- <br /> . .....XZ av <br /> ----------- <br /> Water Supply: Public System and name .._-- ....lN..... ..s ``..........................................................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat❑ Sandy Loam {] Clay loam ❑ <br /> Hardpan 0 Adobe ill 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 sideps <br /> NEW INSTALLATION: IN* septic tank or seepaoe,pit ,permitted if public sewer is available within 200 feet.} "V <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size................................................ Liquid. Depth .................... <br /> . r <br /> Capacity_ ------------- -Type --• ----....•....... Material.................... - No. Compartments ..................... <br /> Distance.to nearest: Well! .Foundation ...................... Prop. Line ..................... <br /> LEACHING LINE [ } No. of Lines .._..................... length of each line............................ Total Length .._...._..... .............. <br /> 'D' BoxType Filter Material ....................Depth Filter Material ............................................ <br /> a , <br /> Distance to nearest: Well ......................... Foundation ............ Property Line <br /> SEEPAGE PIT ( I 1 Depth _-- ..... Diameter ................ Number ............................ Rock Filled Yes ❑ No <br /> __.. .......... - _._. , . <br /> ❑ <br /> Water Table Depth ----••---•-•-•....................:............Rock Size .............. ................. <br /> Distance to nearest: Well ........Foundation .. Prop. Line <br /> REPAIR/ADDITION IPrev. Sanitation Permit# ............. _ .---- Date ................................I <br /> Septic Tank IS eci •Re uirementsI ........ ----- ...: ............ .. <br /> Disposal Field S ecif Requirements) ___... ..... <br /> ------ ----------------• - --- ----------------------------------•-------- ...........:.................................................... <br /> (Draw <br /> 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 shalt not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ----------- -- ------- --------------_---­--- Owner <br /> �4< <br /> BY i... -.. ' Title ------------•---- ----- ------------ <br /> -.._-. . <br /> If other than owner) <br /> DEPARTMENT USE ONLY <br /> APPLI TION ACCEPTED BY . <br /> ----•-----• --------------------------------------------------------------- DATE -- T" <br /> BUILDING PERMIT ISSUED -. .... . - --.--................DATE ........... ----•------------- <br /> ADDTIQNALCOM _ .. ..•------•.................................•---•.....-------._.._.-.-...-•--------------.----_-------- -------•------- ......... <br /> ..........:...............,� --- <br /> -----------1-1-------- <br /> � <br /> . <br /> ---------- - ----- <br /> ---- - --------------------------------------------------- <br /> # <br /> ---------- ----------------- ------------- -- ----- ---- ----- ------------------------------------------------------------- ................. <br /> Final Inspection by: ..--- - ._ ..:.. "....................Date ... .:. ..--.....__... <br /> EH 13 2h 1-68JO UIN LOCAs_ HEALTH DISTRICT 8A h 3M <br />