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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No: ­__7_q <br /> {Complete in Triplicate) <br /> ------------ too5-- �7 <br /> Date Issued <br /> --------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to constru t and install", <br /> nsta 1 the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> .JOB ADDRESS/LOCATIO N--`jl.�-- ,___-- rz - ------04- -------CENSUS TRACT --------Lf <br /> -- -�--------------- <br /> Owner's Name --------------------------- - ------Phone -------- ------------------ <br /> Address _.I W(---- -- - --- ------IG- City <br /> ----------- -----License # -� V- 3-f-°YPhone ------------------------------ <br /> Confiractor's Name ___ --------- � /►�-�--- `¢ � <br /> ------------ ------ ----- -------- <br /> Installation will serve: Residen a QQ Apartment House❑ Commercial :❑Trailer Court ;❑ <br /> Motel ❑ Other ---------- --------------------------------- <br /> Number of living units--------r--- Number of bedrooms ---3----Garbage Grinder ------------ Lot Size __.__/b__ -----.---- t <br /> Water Supply: Public System and name ------------------ ----------------------------------------------------------------------- -------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ It Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam 'E] <br /> Hardpan [T 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 ublic sewer is available within 200 feet,) <br /> `'i i i t <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size_Y'_ ___,!_�__q_--_l�---------------------- Liquid Depth - _______________-.----- <br /> Capacity 1,9a-v-------- Type __-- c ---- Materia "i No. Compartments --- .._----_•-•- I <br /> Distance to nearest: Well --------- ------------------Foundation ------10--/------ Prop. Line __ -- ------ <br /> LEACHING LINE [41 No. of Lines ------a�L--- ------ Length of each line------------f-��-.----__ Total Length .____-���__..-_.--- <br /> �r <br /> 'D' Box -t1____ <br /> .__ Type Filter Material _--____S_�-_,Depth Filter Material -_____-I__(_______________________Distance nearest: Well ----- ------------ Foundation --------t a..------- Property Line, _______+: .......... <br /> SEEPAGE PIT [' Depth ----142__S _- __ Diameter .___ __ __ __ Number -------------- -----_ Rock filled Yes [ No 0 <br /> Water Table Depth ---------- 0 /---------------- ----------Rock SizerL - -r --� `- <br /> r <br /> Distance to nearest: Well ---------- -F ? ---------------•Foundation Prop. Line _._ ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ____________________-'------------y A� <br /> � 1V <br /> SepticTank (Specify Requirements) ------------------------------------------------------------------------------- --•-----------:----------------_---------------------------- <br /> I <br /> DisposalField (Specify Requirements) ------------------------------ ------------------------- ---------------------------------------------------------------------------- 't3 <br /> P --------------------------------------------- ---------- ------------------------•----------•-- �} <br /> ---------------------------------------------------------- <br /> ------------------------- --- -- - -- <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: [� <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 ----------- --- --------------- --- - ------------ -- - -- --------- ---------------- Owner <br /> BY ------------------------ - - - --�- -- �� � -- --- � � Title &,., -- P_ -------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY '': ------------------------------- DATE _ ._ 7------------------ <br /> BUILDINGPERMIT ISSUED -------- -------------------------- ------------------------------------- ------------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ---------------------------------- ------------------------------------------------------------------------------------------- --------------- •------------- <br /> ------------ ------------ ------------------------------------------------------- <br /> -------------- <br /> b <br /> ------------------ --- '- - - � <br /> ---------------- Date -d -------- y------- <br /> 4to <br /> -------_ - <br /> --------------------------------------------------------- <br /> - -- ------------ <br /> Final Inspection <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I <br /> E. H. 9 1-'68 Rev. 5M. <br />