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FOR--OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------- Permit No.'7 <br /> ) r f (Complete in Triplicate) <br /> - ------ --- <br /> Z_411!�---------- Date Issued. <br /> 10 Y This Expires 1 Year From Dat6 Issued A I <br /> Application is hereby made to the Son 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/LOVSION - ------------ <br /> ------Ir�_ ------- ----------------------------CENSUS TRACT -------------- ----------- <br /> Owner. 'A &g� - <br /> Owner's Name -------------------------------------- -----------Phone 200��--------- <br /> Address ------------ ------ ------------------------------------ City ------------------- <br /> Contractor's Name -- ----- -- ------- <br /> -----------------License # ---- Phone <br /> Installation will serve: Residence;<Apartment House,F] Commercial E]Trailer Court ;E] <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:--- ------ Number of bedrooms ---Z?---.Garbage Grinder ------------- Lot Size -----____________________ <br /> i <br /> Water SURPIY: Public System and name �Iel��--------------------------------------------------------------- Private El <br /> Character of soil to a depth of 3 feet. Sand'o Silt L] / Clay E] Peat EJ Sandy Loam ❑ Clay,Loam ❑ <br /> Hardpan E] Adobe�Fill Material ___________,If yes,type _____------------------------ <br /> (Plot.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 20,0 feet,) <br /> - <br /> PACKAGE TREATMENT [ I SEPTIC TANK![ Size-------------------------'-- ----------------------- Liquid Depth -------------------------- <br /> Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ----------------- <br /> i T <br /> Distance to nearest: Well --------------------------- ounaon ---------------------- r . ------------- -7------ <br /> I <br /> ------------------------------------FoundationPopj Line - �1. <br /> LEACHING LINE No. of Lines .------------------------- Length of each fine____________________________ Total.; Length ______.____-___-__.____-_-__ <br /> 'D' Box ------------ Type Filter Material -------------- ______Depth Filter Material J _____.______________________ <br /> Distance to nearest: Well ------------------------ Foundation ---------i-------------- Property Line __________________._-___ <br /> SEEPAGE PIT Depth -------------------- Diameter ---------------- Number ------- ---------- Rock Filled Yes No ❑0 <br /> Water Table !Depth ----------------------------------------- ------Rock SizeY_J----------:------- --------I- <br /> Distance to nearest: Well -------------------------------- -------Foundafio .-i------- <br /> ----------- Prop., Line ---------------------- <br /> REPAIR/ADDITION(Prev, Sanitation Permit# --------------- ---- -----------------�__ Date ---------- ------------ <br /> -Sep'tic Tank (Specify Requirements)l---------------------------------------- ---------------------- ------- ---------------- <br /> --------------------------- <br /> D U,s s ------ <br /> is' I Field (Specify Requiremen s <br /> 4 t9b <br /> 0 Ix d V <br /> I---------- ------------------------ <br /> --------------------- -------------------- A r <br /> --- ---------- ----------------------------------I-----------------------------------------------------I----------------------------------------------------------------------------------------- <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 Loca"i Health District. Home owner or licen- <br /> sed agents signature certifies the following: i r <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any'ptrson in such manner <br /> as tolbecome subject to Workman's Compeniation laws of California <br /> Sign .. <br /> g --------------- - -- - -------------------- -Owner <br /> By Pne- ---- ---------f ------------------ <br /> ec-,Oe—---------------------- ------7 i t 16—,55_,�_-�f_ 01" <br /> ----------------------- <br /> 4 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- <br /> ___ - - - -------------- -- --------------- DATE 74 <br /> BUILDING PERMIT ISSUED ----------------------------- ---- ---------_;-- -------------------------------------------------------DATE -------i------------------------------- <br /> ADDITIONAL COMMENTSI --- - ----- ------ --------- - -- I . <br /> - - - - - -- - - - -------------------------------------- <br /> ----------------------- -----------------------I------------------------------------------------------------------------------------------------------------------- -------------- <br /> ----------------------------------------------I----------------------------------------------------------------------------------------------------------------------------------- ------------------- <br /> ------------------------------ ---- <br /> -- ----------- ---------------------- -------------------------------------------- 6 L----- <br /> ------------------------------Date ------- ------------ <br /> Final Inspection by: -- -- ---- -------- ---- ---- ---15�,- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M I I <br />