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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ................. ` <br /> ;Complete in 'Triplicate} Permitf`lo. ....7 .7 <br /> This Permit Expires IYear From Date Issued Date issued <br /> Application is hereby made to the San Joaquin Local Health District for a <br /> q 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 /> t <br /> JOB ADDRESS/LOCATION ...-7,3, 6.--- - ..-. ... - -..-.._."...................CENSUS TRACT . <br /> Owner's Name .................. '1,__---_ . :.. Phone._. <br /> 22 ff <br /> Address ....................... �•- ­VCa<. _.. ---------- . . City ..... ................................... <br /> .. <br /> Contractor's Name ................... .. . .. --...__ .....---. _... CLu!J:-------•License #2 - -�--. Phone .A - �It�... <br /> Installation will serve: Residencej!dApartment House❑ Commercial'❑Trailer Court fl <br /> MotelE] Other ----•--------------------------------------- <br /> Number of living units:....._ _.,. Number of bedrooms _--3_-...Garbage Grinder _... Lot Size ............................................ <br /> Water Supply: Public System and name .........___......................................................... I ......................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ ' Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material ............ If yes,type ............................ <br /> _111 � ``!! <br /> lPlof plan, showing size of lot, location of. system in relation to wel(s,-buildings, etc.•must be placed on reverse side.) A <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 .......................... G <br /> �.. <br /> Co-Po city --_-• Type:--.................. Material--------- = .... No. Compartments <br /> Distance to nearest: Well �' - •_.__ .....------.Foundation -----r�N::............ Prop. Line -...................... <br /> LEACHING LINE [ 3 No. of Lines . Length of eaclt"line............................ Total...length -.---....... ........... <br /> D' Box ............ Type Filter Material s J -"` � <br /> .---------:-•_•--...Depth Filter Material --....................----.............. <br /> ,--. <br /> Distance to nearest: Well ....... Foundation Property Line ............. <br /> i SEEPAGE PIT [ ) Depth ........... Diameter '"".:`'; _:.' Number=._.._—: ..... Rock Filled Yes ❑ No 'o <br /> [ Water Table Depth..­­ Rock Size <br /> Ik Distance to nearest: Well ........................................Foundation .............. Prop.- Line ....... ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit 5 ........................... Date <br /> t Septic Tank (Specify Requirements), .. ...-t--•=............. --•. _ _ <br /> 1 Disposal Field (Specify Requirements) .4_-. ... :Q....---_� .[ �----------- <br /> {. ••................................---------------------. S . <br /> .................................................. <br /> o (Draw existing and required addition an reverse side) <br /> I I hereby certify that I have prepared this application and that the work will be done'in,?accordance with San Joaquin <br /> f 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 become subject to Workman's Compensation laws of California." <br /> Signed ....... .... <br /> ­4__,.__,._6."_ ­----------------­-­------------- litle......... ..................... .................. <br /> {I oth than owner). <br /> FOR DEPARTMENT USE ONLY x <br /> APPLICATION ACCEPTED BY - � Xs e�... ...... •........... ..�RDE ' ..1'��.._� ..� .......... <br /> BUILDINGPERMIT ISSUED ------------------------------•--_------ -----------------:.............................................DATE g..........-................................ <br /> ADDITIONAL COMMENTS ....................................... .•---.-...... <br /> .............................. <br /> ............................................ ..-•---•-----...............I.------.... --...-•----.•.. --•...........................---•......................•-----...........__. <br /> f ....... ........_... .....................---•---------- <br /> .. . . . .............. <br /> Final inspection by: .- . - - •---- e ..._... <br />� ---. -. -• -- - -- - -....---- _�....:----•...----•........................................Date ...d .�-..:.::�: .. <br /> SAN -JOAQUIN AOCAL',HEALTH DISTRICT _ w <br /> E. H.13 24 1.'68 Rev. SM 7171 4 u <br />