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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT � S� <br /> . ---------- Permit No <br /> - - . � <br /> (Complete in Triplicate) _S <br /> � I <br /> --------------------__/0 <br /> ---- : This Permit Expires 1 Year From Date Issued Date Issued �_-//_- - <br /> 1 <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 Regulations: <br /> JOB ADDRESS/LOCATION .- _--1-Qf- �L_---- iP� / T�, fC ---lea------------------------------------CENSUS TRACT -------------------------. i <br /> Owner's Name --------------54,#'1 R--------- ------------------------------------------------ ---- ------- --------------Phone <br /> Address ......... ---------------------------------- -------------------------------------------- City _v–a Gk'T-$�-t!V--------------- <br /> Contractor's Nam �.e -.fkrS______- 7-Y— -------------------------------------License # f_7 . __-- Phone 410 _.3v7l5-------- <br /> Installation will serve: Residence AApartment House❑ Commercial ❑Trailer Court i❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:-.-/------- Number of bedrooms J.-----Garbage Grinder/V C Lot Size -_------------------ ; <br /> Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private <br /> Characterof soil to a depth of 3 feet: Sand'❑ Silt❑ Clay [❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe L Fill Material ------------- If yes,type ------ --- r-------------- <br /> (PI'ot 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,) IL <br /> PACKAGE TREATMENT ( ] )SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth -------------------------- <br /> Capacity ----- --------------- Type -------------------- Material-------- ------------- No. Compartments ------ ----•-•----_-- <br /> Distance to nearest. Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- <br /> LEACHING <br /> ---_--_- ------LEACHING LINE [ ) No., of Lines y -------------- Length of each line_-----_-------.------.----__ Total Length ---------------------------- <br /> I - <br /> Box ------------ Type Filter Material --------------------Depth Filter Material ------------------------------------------.. <br /> Distance to nearest: Well --------------------------------- Foundation ----------.--------- .- Property Line -_--__-_--------.----- <br /> SEEPAGE PIT [ ) Depth ------------ ------- Diameter ---------------- Number __--___-_---_----.___- Rock Filled Yes ❑ No i❑ <br /> Water Table Depth ------------------------------------------------Rock Size --- ------ <br /> Distance to nearest: Well ------------------------------Foundation -------------------- Prop. Line --..--_.--.---.-.----- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---_-_---_--_-----------------} i <br /> SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------------- -------------------------.... t <br /> Disposal Field (Specify Requirements) ----------7F----- f} e4_ !/V L^.----010 Q-----a f`X---5.3-------P./r-- ----- <br /> ------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------ <br /> (Draw existing and required addition on 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: i <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 t <br /> as to becom subject to Workman's Compensation laws of California." <br /> Signed ------� F Owner <br /> BY ------------------------------------------ ------------ ----------------------------------------------- Title ------------ <br /> ---------------- --------------------------- <br /> (If other than owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..... �== --------------------------------------------- -------. DATE --- --- -------- <br /> BUILDING PERMIT ISSUED _ ----- ------- -------- ----------- -------------------------------- - DATE'- --- ------ <br /> ADDITIOL MENTS --- ------- ---------- ---------------------------------------------------------------- --------------- <br /> ----------------------------------------------------------------------------------------- <br /> -------------- <br /> ----------------------------------------------------- <br /> - --------- ----- - -------------------------------------------------------------------------------------- --- - - <br /> Final Inspection b Date - -."-. <br /> - - ------- -- <br /> SAN,JOAQUIN LOCAL HEALTH DISTRICT J <br /> E. H. 9 1-'68 Rev. 5M, <br />