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FCrR OFFICE USE: APPLICATION FOR SANITATION PERMIT —L. <br /> Permit No. . — ��s-.-- <br /> �f - ------------------------------------------------------ <br /> ----------------------------- - -------------- (Complete in Triplicate) <br /> --------------------------------------------------------- <br /> Date Issued <br /> This Permit.Expires 1 Year From Date Issued <br /> -------------- <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 . cam'""! (." `' ---------------------------------- ----CENSUS TRACT ----•---------- --=- <br /> Owner's Name ----Phone.T� ----7 -- <br /> - <br /> - - -- <br /> Address -------- ------------ - City `< . <br /> Contractor's Name ---------- s0-z- --------- -------License #10?P -------- Phone _144-:7&4.7 <br /> } Installation will serve: -"Residence [Apartment-House F].Commercial ❑Trailer Court ;0 <br /> Motel ❑Other --------------------------------------------- <br /> Number of living units:-------/"__ Number of bedrooms -7ZrfTn--Garbage Grinder- �_""�L,ot Size 77_ - I------------ <br /> --------------------Private ❑ <br /> Water Supply: Public System and name ------------------ ---- " -- <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan E] Adobe ❑ Fill Material ------------ If Yes, type ----------------- ---- -' <br /> {Phot pian, 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 /> 1 PACKAGE TREATMENT [ ] SEPTIC TANK.[ ] Size------------------------------------------------ Liquid Depth -------------------------- <br /> Capacity <br /> ------------------------- <br /> Ca acit ------ Type -=------------------ Material------ --------------- No. Compartments --------- ---------- <br /> c �••.:. 4 <br /> =- Distance to nearest: Well ----------------- <br /> -------------------Foundation _.--------------------- Prop. Line -------------•-------- <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line.-.- ------ Total Length ---__-.-_------------------- <br /> ! -.De' th Filter Material -------------------------------------------- <br /> Distance <br /> ---------_" <br /> 'D' Box .---------- Type Filter Material -------•---------- p ---- ------------------------•- <br /> # � - Property Line. -------•----------- <br /> Distance to nearest: Well -."""""__"""""__-"""""__ Foundation ".""___"""",__"."""_._ p ty • - <br /> - 1""__________________ """_" Rock Filled <br /> Yes (] No C1 C <br /> SEEPAGE PIT [ ] Depth --- Diameter ----"--_.--""__" Number ", <br /> i Water Table Depth ------------- -----------.Rock Size --------------------------- <br /> k, Distance to nearest: Well ----------------------------- ----------Foundation -------------------- Prop. Line ---.------------_---- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --.----=------------------ ---}�-------- Date --------------------------------- <br /> ------------- <br /> ---._-_--___------.----------- -) <br /> Septic Tank (Specify Requirements) -- ----- I ---=i---- -------- -------------- <br /> Disposal Feld (Specify Requirements) ----------- ------- ------------ ---------------------- ----------------------- --------------- <br /> --------------------------`-.-------------------------------------------- ... �s <br /> --- G�=`'`"'� 16-7----------------- -------------------------------- - - <br /> �- ------------- ------------------------ ---------------- <br /> -------------------------- --:-------------------------------------------=------- -------------------- ----- - ------------------ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepureci,-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. Horne 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 subiect to Workman's Compensation laws of California." � <br /> Signed --------- ------- ----- ------ _ Owner <br /> ` (f, Title ------ '------------- -------------------------------------- <br /> BY •�° <br /> (!f of r than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _._-- ""__-- " - ----------. DATE --""_a- " -,-• - a"'----------- <br /> --- - ----------------------------------------------------------------- <br /> BUILDING-PERMIT- ISSUED -------- ----- ------ - - _-- -. <br /> ---DATE <br /> ADDITIONAL COMMENTS,-------------------------- ------------- --------------=-------------- <br /> t. ------------- <br /> � . <br /> - -- ------------ ------------------------------------------------------------------- --------------------------- ----- ----------- <br /> Final Inspection b i -------------------- ------ ---------------- -------Dated � ` <br /> S-AN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />