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{ FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ................. ..................................... <br /> Permit No. `_ <br /> (Complete in Triplicate) ................. <br /> ......................................................... This Permit Expires t Year From Date Issued <br /> 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 __: ..' .......1. .-. ..... e ._ .,�� -.:.......cENSUSTRA ...........:...9...., <br /> Owner's Name .......9.e_AA-s,...WA..At............ -- Phone <br /> ...------... ...... ............ ---.•............................... <br /> Address .............._ ...�� ....�'T 5...---- y' �s ,�.�! t.c. .................. .. City ....................................................................... <br /> ..... <br /> :� <br /> Contractor's Name ..- ; '`� '..:... -------------....... License # .7/.F3 5------ Phone _Y - _1 -------- <br /> Installation will serve: Residence artment Houses] Commercial OTraller Court 0 <br /> Motel {]Other----- --------------- <br /> Number <br /> - ------------Number of living units:___. '__ Number of bedrooms _ __... arbage Grinder;___-__..__.- Lot Size <br /> II <br /> Water Supply: Public System and Warne -__-•- _t.,_ _� :._-__--L"��-►--- -f---...................-----•..:............ <br /> .Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ `)Clay Peet Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe Ug?-Fill Material .... If yes,°type ............... ............ <br /> (Plot plan, showing size of lot, location of system in reldtian to'wells, buildings, etc. must be placed on reverse side.) I <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ].. SEPTIC TANK{ ).. . _ Size............... .......1= _-.:.-----_..—Liquid Depth <br /> Capacity e ' ' <br /> Yp Material: =� Na. Compartments ---------------------- <br /> Distance to nearest: Well ----------------------------------- <br /> -------•---•--'--...__ Prop. Line ...................... <br /> LEACHING EINE [ J ' No. of Lines --------------- -------- Length of each'line-.__:_...._._..±:--....._... Total Length -._-........................ <br /> D' Box Type Filter Material ....................Depth Filter, Material <br /> Distance 'to nearest: Weil ....................I.... Foundation ............... :....._. Property Line <br /> ........................ <br /> SEEPAGE wPIT I e th �:_._. Diameter Rock Filled Yes ❑ ;No 0 <br /> • a ✓ <br /> p .��,-----._. , , ..._. ---•--•---...... Number ..._..-----• - _....:. . <br /> ' Water>Table Depth ---- _ -----------------Rock Size ..................... <br /> Distance to neatest: We I ..-...._---_-- -------•.............Foundation -------._____....... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .... ---_--------------__--•--------... Date .-.---__- .............. <br /> E <br /> Septic Tank (Specify Requirements) _.. V----•-••-••-.-.._.,.-•--- ------------------/...._..----- f <br /> Disposof Field (Specify Re €rements) ............r............ / .. . <br /> r <br /> Xoe <br /> -- -------- ------- ' 7}'/ . ---- .P.r�. ----- ---------- ---------------------------------------------- --•_...__.._...- <br /> ------------------------ -------••-•----------------------- -• --•-------- �- --------«-- ; ---------------------------------------------------------- . <br /> lDraw existing and required d8dition 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. Hoene owner or licen- 1` <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 N <br /> as to became subject to Workman's Compensati6n' laws of California:" y' <br /> Signed - --------- --- Owner <br /> By -- • -..._ ------- ai "'... ----.._... .Title .. . .- <br /> (if t er than owner) I <br /> FOR DSP TMENT USE ONLY <br /> n <br /> APPLICATION ACCEPTED BY - C ----------------- DATE . = <br /> BUILDING PERMIT ISSUED __:..__DATE --------------- <br /> ADDITIONAL COMMENTS -----------------------------•-•-•-•- 1-1------------------- .------- - ---.. <br /> ------------ <br /> Final ins - <br /> ------------- --- ------------------------------- .......Inspection b <br /> pY- ------------ - --• --------.. _...__._.-•-'-----------......................... -�-.................Date <br /> ..._.-1 .-�.��..� -- -•------ <br /> EH 13 2h 1-68 ;Rev. !;m SAN JOAQUIN LOCAL HEALTH DISTRICT $�7� 3M <br />