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FOR OFFICE USE: <br /> APPLICATION POR eSANITATION PERMIT 7 <br /> ........... ......... --......... <br /> (Complah in Tsipileate) Permit Na. <br /> ............................................... <br /> ............................ This Permit Expires 1 Year From Dot*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 wit? �[unt Or/dinnan N 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOC ION ��X. -.��. i �/'� <br /> .... ...............................................................CENSUS TRACT" .............f................ <br /> Owner's Name .. ._._/ ... .. ........ ....................•.....I......... j.y.........Phone <br /> Address __.._. . ... <br /> .�_'i�... .. --... City ��1� .. -•---•----•-•-- <br /> _.. <br /> Contractor's Name . _ ._ .. . . License# ........................ Phone ..................--•------•-- <br /> V------------------------------------------------------ <br /> Installation will serve: Res' encs(`Apartment House f3 Commercial❑Trailer Court ❑ <br /> Motel ❑Other----••..................................•-•- <br /> Number of living units.-.--.I... Number of bedrooms _. Z_...Garbage Grinder ............ Lot Size ....... .............................. <br /> Water Supply: Public System and name .........................................................-..........---.......-----..............._...........Private ] <br /> Character of soil to o depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam C3 Clay Loam ❑ <br /> Hardpan [] Adobe V 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 f ] SEPTIC TANK I 1 Size................................................. Liquid Depth ..........................f <br /> Capacity ... ---------•- Type .................... Material.--•--• ............. No. Compartments ...................... <br /> Distance to nearest; Well Well ----------..........................Foundation --------------_----- Prop. Line __.. ._.._.._ .._ -.E <br /> LEACHING NG LINE - No. of Lines .........1-........---- Length of each line.__._-...6.o.Ft---- Total Length _....._.�_� . ;F, <br /> D' Box ....._.._... Type Filter Material ...1rac�C Depth .Filter Material .........� .�� �..g.............1p <br /> Distance to nearest: Weil ...... ..............._- Foundation ..._--------------•_... Property Line ....-J '617e........ <br /> SEEPAGE PIT [ ) Depth ... ----------- Diameter ................ Number ............................ Rock Filled Yes ❑ No C <br /> Water Table Depth -----------------•-•---------•• ----------------Rock Size •............................... <br /> Distance to nearest: Well ........................................Foundation .................... Prop. line ...................... <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ----.._-.-•.-_--- ._----.-- Date ..................................) <br /> Septic Tank (Specify Requirements) .................. ... .... ___ ...----.-... <br /> Disposal Field (Specify Require m nts) - �!•. /P •........�`D------- .l..d..�.�........... <br /> .. _ <br /> � ►_.._..1 c.n e t- ....--.--._ . .s...-----r............., <br /> •- •-- -------­--------­---- ....-.....•-...........................:......................................................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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 shall not employ any person in such manner <br /> as to beco s t to Warkm 's Compensation laws of California." <br /> Signed ........................ <br /> .............•--- --- Owner <br /> By --------------'...---- ••-•-----•............. title .......... ..................... <br /> (If other than owner) <br /> FOR D PARTMENT USE ONLY i <br /> Z I <br /> APPLICATION ACCEPTED BY -•-----•--•-----••-- -----••--• . DATE ....... <br /> ._ ... .__7�_......: <br /> ............... <br /> BUILDING PERMIT ISSUED ----------••----------• ........................ .._DATE •-----..-- • <br /> .-----..__.. <br /> ADDITIONAL COMMENTS ---- <br /> -------------•---------------••------------.-...-----•-------•-•--••----------------._ I <br /> ••-------- ------------•• ----- •--------------..-------• - ..... <br /> . • ... -•- <br /> Final Inspection by: ....................... .. • -------- .__ .----------........_....-----.._....._...._.... ..--_._._Date -- . ......- -. <br /> EH 13 2h 1-68 Rev. � i <br /> SAN IOAQUIN LOCAL HEALTH DISTRICT' � 8�7li 3M <br /> - I <br />