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FOR OFFICE USE: 2 <br /> � f <br /> APPLICATION-`OOR SANITATION PERMIT <br /> ----- - -------------------t' � Permit No. -7c--/O.z g'. <br /> (Complete in:Triplicate) <br /> ---- This Permit Expires 1 Year From Date Issued Date Issued <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 /'._. a- ------------CENSUS TRACT -------------------------- <br /> Owner's Name --- r /°_/ ......._ Phone <br /> - <br /> ----------- <br /> Address -114V 7-------k,:5 <br /> Contractor's Name ----- Q �-`�-- -- , .....................-=--------License # ,�1s . ;_?�?Ohone ------------------------------ <br /> Installation will serve: Residence X.Apartment House,[-] Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other--------- ----------------------------------- <br /> Number of living units:.-/---- Number of bedrooms __.__.Garbage Grinder/�� Lot Size --__________ <br /> Water Supply: Public System and name ---------------- -----•---------------------------------------------•------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam El <br /> Hardpan E] Adobe EW, Fill Material ------------ If yes,type ____________________________ <br /> (Plot plan, showing size of lot, location of system,yin relation-l3o wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: {No septic tank or seepage pitipermitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT [ SEPTIC TANK f J V i ► Size --------------------------------------------- Liquid Depth --:---------.._-..._------ <br /> Capacity -------------------- Type ----- Material-__-=Material-_---- "-` ".No-"Compattments ---------------------- <br /> Distance to nearest: Well _________________________________Foundation ---------------------- Prop. Line -------------:_.______ <br /> LEACHING LINE [ ) No. of Lines _______________________ Length of each line--------------------- ------ Total Length ___________-_-__---._..-_-_. <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------._-=-------------.----•- <br /> Distance to nearest: Well ________________________ Foundation --------------------r"_ Property Line ________..______----.... <br /> SEEPAGE PIT [ ] Depth ____________________ Diameter __-__________ - ❑ No (-j-__ Number�____________________________ Rock Filled Yes <br /> Water..Table,Depth-------..........:----------------------------------Rock Size ----:-------- { <br /> Distance to nearest: Well• ________________________________________Foundation ----------------- Prop. Line _-------..____-_-___-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------..---;------------------------------- Date ----------------------------------) ' <br /> Septic Tank (Specify Requirements) --- <br /> ---- -- --- --------- <br /> Disposal Field fS ecify Re uirernetsts4} __ ___ _ __ _____________ <br /> M1. u1 <br /> C= -----------------------j--------- ------------- <br /> ------ --- ------ ----------------------- --------------- - <br /> (Draw existing and required addition on reverse <br /> ! ii <br /> hereby certify that I have prepared this application and'that ,the work will'be done n~accdrda`nt with'San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations-of the San Joaquin Local Health District. Homeowner or licen- <br /> sed agents signature certifies the following: `t ' t <br /> "I certify that in the performance.of.the-work-for_w.hich this permit is issued, I shall not employ any person in such manner <br /> as to become iUbject to Workman's,Compegsation.lmo!s.of California." <br /> - . <br /> Signed ----------------- -------- --- ----------------------------- Owner <br /> BY. ------ Title ----------------------------- <br /> s (Ifo r t�nowner) I " <br /> i i <br /> .,FOR DEPA-ItTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---- - _ ___. DATE --- <br /> 'BUILDING <br /> - <br /> ----- - -- -- - ------ ------------------------------------------------------- ------ --- <br /> 'BUILDING PERMIT-ISSUED ------------ t DATE ----- ----- ----------- -----------------_ <br /> ADDITIONAL COMMENTS ------- IhA- �� 1- = <br /> ` _? ------------------ <br /> --------------------------------------------------------------- <br /> - ------------------ ---------------------------------------------------------------------- <br /> ---- <br /> 3 � <br /> - -,,((-�� - --------- ---- — r-------------------------------------0 -h- <br /> Final <br /> Inspection by: .------,r(;f_ - i- - - - - ----------DateSAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M Cel ,l V ,� �-t rb .K-i <br />