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FOR OFFICE USE: •� <br /> APPLICATION FOR SANITATION PERMIT �aa <br /> --�- - ------------- Permit No. <br /> .. (Complete in Triplicate) <br /> - <br /> _________________________ This Permit Expires 1 Year From Date Issued <br /> 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 compl�ith Ctunty Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCA---�T�I--ON __ 8 ___�v - - ----- ------------ CENSUS TRAACT <br /> Owner's Name 4►_t_!`�}- ]�i[15tIE------------------------•-••------------------- ------------------- --------------------Phone <br /> Address -{� 0 -------------. City -i7 / Grp + <br /> Contractor's Name ._.__�6J _`f'_ �__ _ __`� -�_-__ _�_______________License #��� -�-I_____ Phone _�_4b7T_Q_0T1. <br /> Installation will serve: Residence [XApartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other ---- _ = --------- -------- <br /> Number of living units:---- 1 ----- Number Number of bedrooms --___-Garbage Grinder ------------ Lot Size ---i_-h_cRiC--------------------- <br /> Water <br /> _____ _____________Water Supply: Public System and name ---------------------------------•-•---------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand F] Silt❑ -Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 <br /> Hardpan [❑ Adobe'❑ Fill Material ------------ If yes, type ____________________________ <br /> (Plot plan, showing size of lot, location of system in rilatiox nn to ells,~buildings,_etc. must be placed. on reverse side.) <br /> NEW INSTALLATION: lNo septic tank or seepagee pit permitted if public sewerisavailable within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK�[4&114cr­ , Size------------------------- Liquid Depth _--_--.----_.__ <br /> Capacity -----------------•-- Type -------------------- Material------- No. Compartments -------------------i-0 <br /> Distance to nearest: Well .-____� ___ -----------Foundation ._____________ _�,____ Prop. Line -__--____-___-__._:' <br /> f .1 <br /> LEACHING LINE [ � <br /> $No. of Lines --____--____-____-_--_ LIn h of each line.__.._____------_------------- Total Length ,___--_____.--__--_.__.__..� <br /> 'D' Box ------------ Type Filter'Materi i _____ ________Depth Filter Material 1. -- <br /> Distance to nearest: Well': /----- -_ - __ Foundation ----------- Property Line <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter --------- Number ----- --------- ---------- Rock Fialed Yes ❑ No'I�r' <br /> -Water Table Depth -- '--=- ------- ---------Rock Size ---- _ <br /> If' I f ^- �' it <br /> .Distance to nearest: Well --------------------- -z.,.._...--__....Foundation ------------------- Prop. Line ................... <br /> REPAIR/ADDITION(PreIv. Sanitation Permit# ---------------------------g-_---------4r---_ Date/------------ _ _-________--___'] <br /> i -------------------------------- <br /> Disposal <br /> . +.�. <br /> Dis tosal Field(Sp'e'cify <br /> Ree u cements � _ --�' •�''--[Q��S�.-------- ------------'-------------�------r�-- --•• --------------------------- <br /> P ( P Y q �-------- <br /> P Y q 1; - - - I ;. _ D ]IC <br /> ------ =`- --- ---- t` -0- ' <br /> ---------------------- Z - !eZ --,c-I? ----- - , n f Y.=_.-..... _.. t - - <br /> N (Draw existingbnd required adrltior4on 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 certifyf,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 becoymt subje t to Workma 's Compen tiep law of lifornia." <br /> Signed t *_n I k '' '� --- ------�-------- ' <br /> 444 <br /> BY ---------- I-------------- Title f� . <br /> -'- <br /> [If other than owner) --1 <br /> PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- = ` a ----------------"----- ---------------- DATE . . ���-7D--------------- <br /> BUILDING PERMIT ISSUED �' ------------------- --------------------------DATE -------------•----------------------------- <br /> ADDITIONAL COM TS ___. _ _-_.____ <br /> -y — '' <br /> �y <br /> - ---------------- <br /> Final'Inspection by: __ ----------- -- Date <br /> --- --- - - ------ ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />