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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> _.....'_.... <br /> ..... .................................... Permit No: ��..r.7 . ... <br /> (Complete in Triplicate) \1 <br />,.... <br /> t This Permit Expires 'I Year From Dale Issued Date Issued .. - <br /> °. ... <br /> _......................................... .......... <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. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIO ... CENSUS TRACT <br /> 3. <br /> Owners Name ........... ...... ....... . ... ._ -. <br /> ..1... C-2�Oif _ :. _.`City?.._. [ .. :.._:.... <br /> Address _ t_ ...._ a <br /> ` - `- = -: ..l'icense # = 11-::''Phone _. ... .. <br /> Contractor's Name . ...... -C.=v��..... C� <br /> i � l <br /> Installation will serve: (' Residence Aptirtment HouseC]:Corn mercial f]Trailer Court . <br /> Mete[0 Other .......... . .................. <br /> umber of living units:_.__,{._------ Number.of:bedrooms, .. .......Garbage.Grinder . .. .... Lot.Size ��:�1`,�'���._._••--••••-- <br /> Water Supply:,Public System and name ---- :.. : __..... riva <br /> ..Private <br /> -�-�Ehaiacter of soil t a depths 3 feefi Sand TD Skit '" Clay[j Peat[] „ Sandy Loam {] Clay Loam ❑ T <br /> �• � Hardpan ❑: YAdobe �' Fi11 Mater+a) if yes,'type -, t '-•'--- <br /> (PJo plan; showingis+ze af.lot, lavation of system-in-relation to vielis,..bu+)dings, etc.' must. be .placed .on reverse side.) <br /> x, <br /> NEW INSTALLATION: . (No septic tank;or seepage ;pit permitted-if-'public sevrer ista.oilable within 200-feet,i z <br /> + PACKAGE TREATMENT [ ] SEPTIC TANK f Size-'-_----: ... .. "..Liquid Depth ---.................. <br /> I ' E� <br /> I Capacity .. Type --- Material.. .... No. ; Compartments ................. <br /> Distance to nearest. Well --•__--:-Foundation Prop. Line <br /> LEACHING LIN i a + ... ' .... . a e -.... ............., ..__... <br /> e.. I'ne .:.. _ -. .. t I` L ngth <br /> E ( ] No. of;Lines ..:.................. .... -� <br /> n tFi. o - <br /> 'D' Boz .: Type`Filter Mafi 9tal ... :- .Depth ':Filter Materia) -- :J `...- ` •" <br /> Distance'to - i <br /> ._._.. Foundation <br /> • nearest: Well:..:......:..::.... � ...:::..:'.....-=---=-- Property Line fr`A ~' • <br /> i SEEPAGE PIT ( � Depth Diameter <br /> ........ Number ^Rock Filled :Yes Q No <br /> Water Table Depth: ............ .............s------ .Rock Size . •-- i <br /> Distance to nearest Well . Foundation;. .Prop. Line . <br /> - REPAIR/ADDITION(Prev. Sanitation Permit# Date --• <br /> `Septic Tank (Specify .Requireriments) ---••-----...... <br /> ................... ..---- ..-.... ---- <br /> ... ..� _ _.. ...._.. <br /> !r. Disposal Field (Specify RequirenaentsJ /�•- .._ .--- <br /> . <br /> ... . . <br /> ........... ;: t <br /> 4.1 <br /> ' (Draw existing and required addition­on'reverse side) <br /> ' I hereby certify that I have prepared this application aind that'the'work will be' done in accordance with San Joaquin= <br /> [;. <br /> {...• County Ordinances; State Laws,-and Riles and'Regilatioris`of-the'San'3bcagiiin'Loial'Health .District:Hbm'e owner, or Uteri- <br /> Wer sed agents signature certifies.the following: . ;.... .. . .t »..' <br /> "I acertify that in the performance of the.work for which this permit is issued, i shall riot employ any person in such mariner; <br /> as to Become subiect to Workririan's Coirrpensafion laws of Californic " <br /> Signed Own <br /> r <br /> B <br /> Y ------......... ...t..: _....._.::: title <br /> Owner, <br /> (If other n owner) <br /> FO ENT USE ONLY I <br /> APPLICATION ACCEPTED BY ... ........... DATE :.._.. r I <br /> BUILDING PERMIT ISSUED M . :.DATE . = ------ <br /> ADDITIONAL COMMENTS •• ............ ... = = ... .. ------------------ ----- <br /> jj .. ..................................... ._ .. F'.... ._..__t._.__�.... ..._... <br /> .................................... .. ._....... .. ......._ <br /> •' .............. <br /> , i _ Date •r0 ............." •-- (o <br /> ... <br /> o <br /> ......... ..... f . <br /> Final Inspection b . ... <br /> ------------­----- <br /> SAN JOAQUIN; LOCAL 'HEALTH DISTRICT <br /> G v <br /> 7J72 3 M <br /> 13 + ,-'�cn ve_ FAA_ — <br />