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rFOR OFFICE USE: <br /> 3--. APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No, <br /> ....................................................... p <br /> ................ This Permit Expires 1 Year From Date Issued 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 Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION 4e�" .......----...................................._........CENSUS TRACT ..................... <br /> Owner's Name .:-.�1 C.}�. /Y ..191V1,,14XS'P./.V......_.-- �i <br /> --- Phone _-- <br /> Address ... ..237 .2ke '--------•---•............................. City ...—57 T_ !----- <br /> Contractor's Name ..f ._„ . �11 ..... , jL�-- ,�.............License # ,1779'67.... Phone .�WV:7 .,W2 ... <br /> Installation will serve: Residence 50 Apartment House] Commercial ❑Trailer Court 0 <br /> Motel ❑Other ............. <br /> Number of living. units:_...__... Number of bedrooms ..t..Z..-_Garbage Grinder ./.S•1.Q__ Lot Size f�.k6_z?.r. <br /> Water Supply: Publi and name .......................................6.......--------------- ........................... Private ❑ <br /> Character of soil to a depth of 3 feet: - Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loom ❑ �� <br /> Hardpan 0 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 /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size--------------------------------------------•--- Liquid Depth .......................... <br /> Capacity .._...------_----- Type .................... Material------------- --_..... No. Compartments ........_.. .......... <br /> Distance to nearest: Well ...................................•Foundation ...................... Prop. Line ._................... <br /> . <br /> LEACHING LINE ( ] No. of Lines .................... Length of each line-_-.....__................ Total Length ....................... <br /> 'D' Box ------------ Type Filter Material ....................Depth Filter Material ._.__.......__.._ ........................ <br /> Distance to nearest: Well........................ Foundation ................... Property Line ........................ <br /> SEEPAGE PIT [ ) Depth Diameter ................ Number ..................---------- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ..........Rock Size <br /> _ Distance to nearest: Well ................ <br /> -----------_--........Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit 1# ---------------- --_------------------- Date .................................. <br /> Septic Tank (Specify Requirements) ........................................ •--••- =...---•-----•-----••--....----••---...----•- <br /> Disposal Field (Specify Requirements) .___._._._.lf.4�5-.7,vvx____....9.7 <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 far 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 California." <br /> Signed .................................................. <br /> Owner <br /> By ............... ................... Title ,. <br /> -------•- <br /> (If other than owner <br /> FOR10;72;t��.. _--_--------------- .............. <br /> D>EPAR MENT USE ONLY <br /> APPLICATION ACCEPTED BY :,.e,. 0_------ F .. DATE .../1.-�.. :' �f ....-------- <br /> BUILDINGPERMIT ISSUED .................. V---------- ............ • -•-•........_... ............................. _..._...-•----....._..............-••---... <br /> ADDITIONAL COMMENTS ............... . .... <br /> ................................• ... -•----• - - _.... .............. <br /> .__ _ ....._..__..... ..... ............................ ---------.......�... ........I....... A.- <br /> .. .......... . . <br /> - -- --- ---- -- <br /> Final Inspection by: .......Date .... .. ........--•-------------- ...... <br /> f ; <br /> N OAQUI.. LOCM. HEALTH DISTRICT ] <br /> 13 24 <br /> E. H. 1 68 Rev. 5M 7172 3 M <br />