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FOR OFFICE USE: <br /> APPLICATION <br /> � <br /> FOR,SANITATIO-N PERMIT.� <br /> h - .No1Co,mplete in Tripicate) _-Permit'. <br /> .4 <br /> ._.. /. . <br /> -------------------------------------------- <br /> - to Issued, <br /> p -- Date Issued ---__-- - <br /> ______. This Permit Expires ] Year From Dg__.. - <br /> Application is hereby made to they San Joaquin Local Health District for a permit to 'construct and install the"work herein <br /> gscribed. This application..it,made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB 'ADDRESS/LOCATION t ` f"-�---r -f ''°°'`' � ��f -- `r ---CENSUS TRACT __LQ `��'1� S <br /> j . <br /> Owner's Name --- l' _ �' �* t ---- ------------------ - ---. .-P one - <br /> Address _.._. ' y r ✓ " ' <br /> :. Ct <br /> Contractor's Name lr � . -License.# � 7t <br /> -- Prone <br /> Installation will serve: Residence ®`Apartment House❑ Commercial;❑Trailer Court ;❑ . <br /> t <br />` Motel ❑ Other <br /> __--------- <br /> __-------- <br /> Number of living units:_-__._.- Number,'of bedrooms:.____,+/___-_Garbage Grinders. i _`;Lot Size _ r ' _ __ Z_---- <br /> Water Supply: Public System and name ----------------------------------- `__ ' Private ❑ <br /> s.. '•v.I 1 _ rk� <br /> Character of soil to a'depth of 3 feet. Sand'[] Silt❑ Clay. © Peat ❑' -San'dy'Loam {] Clay Loam ❑ ,ter <br /> i Hardpan ❑ Adobe.•g Fill Material - ---------- If yes, type _________________ ____ _ _ <br /> . h! <br /> (Plot plan, showing size of lot, location. of system in�relation''to=wells, buildings etc. rst.'be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit p`ermitti''� ed if. Oublic sewer is avntailable within 200 feet,) <br /> 4 _ ..._, <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ _ Size _ ' -_ .__ _____._ Liquid Depth ----- ' <br /> - <br /> capacity Types " "� Mafierial_4 No. Compartments ----------- <br /> f, <br /> Distance to nearest: Well __-------_�_____ _ --;__-___Foundation _____.____-_ Prop. Line _, <br /> LEACHING LINE :.{' No. of Lines;'- ,------ _- ' k 'L'ength'of.;each line`:`.� _ _::____ Total Length ._ --------------------- <br /> 'D' <br /> "_'?� _----_ -- <br /> I1 <br /> 'D' Box __�.+` - Type Filter'Mciterial A------eA'_ Depth .Filter Materia) ---.�!--------------------------------. <br /> . ,'le <br /> Distance to nearest: Well _--------------------- Foundation- _.-/4.;-------------- Property Line ... _m-.- � <br /> �s <br /> SEEPAGE PIT [�] Depth ___;_�:. _ _ Diameter - Number _- .------------------ Rock Filled Yes No .01 <br /> Water Table De 'th -- `. ------ _"�_._? ',* <br /> � P - ----------Rock Size - --P -� - �-------- ----- <br /> Distance .4 <br /> to. nearest: Well - '-_------------------ ----------Foundation 2�--------_---. Prop. Line ---I'-_":--_:-------_-_� <br /> .. . . ------------ ----- Date 1 <br /> REPAIR/ADDITION[Prev. Sanitatiory Permit# ____-_________`__-___ ._ - ----- _---------------------- <br /> � <br />` Septic Tank (Specify Requirements) - <br /> ) --- --------- ------------ -------------------=-------------------.----------------- ------- ----- - --------------------------- <br /> ------------------------------'--- --=-::--=---=-----------=----=----------- ---DisPosal Field (Specify Requirements) --- <br /> ------------- � � <br /> i 1 , r <br /> -------------------------------------------------------------------- _ _ , _ <br /> ------_----_--_____---------_-_..__--_------__.----- ._---------- ---.-_--._______________ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I haveprepared this application and that the work *ill'6e done in accordant with in <br /> pp e f San Joaquin � <br /> County Ordinances, State Laws, acid Rules and Regulations of the San Joaquin Local Health District. Home,ownef orVicen- <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 become subject t7Wo,ktnan�s Compensation laws of California." <br /> Signed /- ------------------- - Owner <br /> ;,1 <br /> BY ------ I r ----------- Title .-------------- ----------------------------... <br /> --- <br /> k. F (If other than owner) I <br /> w FOR DEPARTMENT USE ONLY ` <br /> APPLICATION ACCEPTED BY ------ = - - DATE .- �7- 7 - <br /> BUILDING PERMIT ISSUED - ---=- = it -------DATE -----------------'--------------==--- <br /> ADDITIONAL COMMENTS ......?___ - ---- -- -------------------- ---•- - - <br /> --------- <br /> 1 _ <br /> ---- - ----------- --------- --- - ---- -------- -,-------------==----------- ----- -------;=-,----------------------------- <br /> - - ' <br /> -- ----- -------- - -----------------------------==------- <br /> Final Inspection by: -, =-� --------- - -- --------------- ---- <br /> --------------------------------------------- ---------------------Date f <br /> ------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M , <br />