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FOII OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ..r..... ............................ <br /> .................................. <br /> .............. - !Complete In Trlplitote) PetmH <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 Regutat(onst <br /> JOB ADDRESS/LOCATION J ZSR d��....�..... ......................CENSUS TRACT ....... ......... <br /> Owner's Name99P.0. -.5..... ........................... ............... Phone <br /> Address !fir .. . ........ tilt ,......................... City ..�� ........................................... <br /> Contractor's Name ,.... _ ......................License2-.. Phone <br /> Installation will serve: esidence❑Apartment House 0 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 foam ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe❑ Fill Material ............If yes,type............... ............ <br /> lPlot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse slde.)� <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if .public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size._. .............. Liquid Depth <br /> Capacity f �� �pe .�� Material...................... No. Compartments - -----........ <br /> Distance to nearest: Well' ..JYP._/ <br /> Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE ( ] No. of Lines .. ---------------- Length of each llne..!� 7 � Total Length -'Q&!.......... <br /> . ' ...Depth Filter Material .e�................................•.. <br /> 'p' Box --�....-.. Type 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 ........I......................... <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line .......... <br /> .. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I <br /> SepticTank (Specify Requirements) ......................................... .........................---.........._.................................................... <br /> DisposalField lSpecify Requirements) ------ ---•---•----•----•.............................................................................._.....-- <br /> ------••..........................•---------•----•--••........-----..._.--•----••--•------...........................-----•--•-..:............................_..._.............................._........ <br /> .........................................._....................._..............................................._............_....._... . <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certlfy 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. Horne owner or licen• <br /> sed agents signature certifies the following: <br /> "t.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 California." <br /> Signed a <br /> .. ...................... <br /> Owner <br /> By ... /.--•-•-----•. .............................•---•••-------•---- . Yitle ...--.................................. ................................ <br /> (lf other than owner) <br /> FOR EPARTMEI,T USE ONLY <br /> APPLICATION ACCEPTED BY --- .. DATE ....:9 .............. <br /> BUILDING PERMIT ISSUED .DATE <br /> ADDITIONAL COMMENTS ............................................... ..:.........................-.. <br /> . ................................••-------•-•---.••---•--------......__............................... ....---................................--•--........................................................ i <br /> .................. <br /> ...............•---- ..................... ..... ..............--- -•---..... l <br /> Final Inspection by: .--.......i�t� :_._.-......................................Date ...Y:77� _........ <br /> ........... <br /> Eli 13 2h 1-68 Rev. 5H SAN JOAQUIN LOCk HEALTH DISTRICT 8/74 3H <br />