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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. -.�S`3-�• <br /> -------- ---------------------- ----- <br /> {complete in Triplicate} <br /> ----- <br /> .___ Date issued _�"__3-- <br /> _ <br /> _ This Permit Expires 1 Year From Date Issued <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 Ord�inance�No. `549-and existing $ides and Regulations: <br /> / r --CENSUS TRACT -------------- ----------- <br /> JOB ADDRESS/LOCA 710 - __ <br /> - /G <br /> Phone. �Pl-� _ ---------- <br /> Owner's Name ------ 1 - ----- } <br /> 10 <br /> Address -- ---------------- --- ------ - <br /> cam[--- ----. City --- -- "- -- ---- -------•-- ---------------- ----•--------•--... <br />- � d%------------- -------License #� -:�- - <br /> 1----- Phone _ � � ------- <br /> Contractor's Name __-------------- ------- -- ---- --- <br /> - --------�- <br /> Installation will serve: Residence�Apartment House❑ Commercial ❑Trailer Court :❑ <br /> Motel ❑Other --- ------------------------------------ <br /> Number of living units:__./-_--_ Number of bedrooms ___Garbage Grinder ------------ Lot Size <br /> Water Supply: Public System and name ------------------------------------ ------ <br /> Private <br /> .—Character of-soil to a depth.of-3-feet: _ Sand❑ Silt❑ Clay ❑ -Peat []� -Sandy-Loam-El - Clay Loam-[Dr-�--• <br /> Hardpan Adobe Fill Material ------ ----- If yes, type ---------------------------- <br /> buildings, etc. must be placed on reverse side.) <br /> (Plot plan, showing size of lot, location of system in relation to wells, , <br /> p seepage P P public p t Liquid 00 feet;} �1 <br /> NK' ize......!- 8------ ------------------- - p l 0 <br /> NEW INSTALLATION: (No septic tank or see a e it permitted if sewer is available within <br /> PACKAGE TREATMENT [ ] SEPTIC TA t Z� D <br /> Capacity .� - Ype --- -- -- -- ---- <br /> Material- ',,N;b:'Compartments - •- <br /> _� ".'�-�'"� �J�� � ---- Prop. Lin ----------- <br /> LEACHING <br /> -----------=-- foundation ---- =ti <br /> Distance to nearest: Well -____Z ___ - � <br /> i <br /> ._ ---_______ Length of ach line------- -------- Total Length :-_ -`�- -------• <br /> LEACHING LINE No. of Lines ---.-- �. tr) <br /> -----De Depth Filter Material -----------�g ----•-----•-------•---- <br /> +✓.y Type aterial P 1 /L- <br /> D' Box ____:-_-- T e filter M � r <br /> 4 d`---------groperty�Line. Jp --•------ <br /> �Dis =-�Foundat-ion `------- -- - v , C <br /> - Diameter ��___ _ Number __-_.--- '--- ---- <br /> Ro k,,Filled Yes No .0 <br /> SEEPAGE PIT Depth <� ii <br /> k <br /> Water Table Depth .............................. _--Rock)Size _ ---- -:�'-y <br /> — —� sg 7 <br /> Foundation --_ ------ -- Prop. Line -___.- O <br /> Distance to nearest: Well ______l-___�---------------------- ... <br /> REPAIR/ADDITION(Pr'ev. Sanitation Permit F# _.----------------- --_- t_-_„l+st <br /> I <br /> Septic Tank (Specify Requirements) ----------------------------- - <br /> Disposal Field (Specify Requirement's1'�';;-------- -- ----------------- ------------------------------- <br /> ­---------------------I-------- <br /> -------------------------------------------------------------------------- <br /> ---------- ------------------------------------------------- <br /> ---------------------------- <br /> ------------- -- ------------------------ - - <br /> ' ----- -- ------------- . ....z4. -. <br /> -------------------------- - . <br /> ---------------- - - - <br /> -- - - <br /> -- <br /> i � (Draw existing and required addition on reverse side) <br /> I hereby certify that I�have prepared this application aLd 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's Compensation laws of Califo a.-,' <br /> Signed Owner <br /> UA-Z <br /> ------------------------------- <br /> ------,- -- ---- ti <br /> • ------------------ -Title --- ----- <br /> ------------------------------------------- <br /> (If other n owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYG --------------------- I------------------- I--------------- <br /> --------� DATE -----�--�-- 7`•f�---------- <br /> BUILDINGPERMIT ISSUED -------------------------------- -s -------------------E-----------------------------DATE _.._._.----------•------------------------ <br /> ADDITIONAL COMMENTS ------------------ ----------------------------------- ---- - <br /> --------------------- ---------------------r---------------------- ----------- <br /> ------------- -------------- --------- -------------------------- -------- ----------f---- -------------------------- <br /> ---------------------------------- <br /> ------------- -------------- .. <br /> -- ------------- r <br /> x - <br /> ------------ ------ ---- --------- -Date -- --- - - - <br /> Final Inspection by: '- -- ____ ._ _ �� ¢„R <br /> SAN JOAQUIN LOGAL HEALTH DISTRICT <br /> c u 0 1_'AR Rav- 5M <br />