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FOR oFlrlcE USE: APPLICATION FOR SANITATION PERMIT <br /> /G_ •1 �' Permit No. <br /> (Complete in Triplicate) <br /> Date Issued/4--------------- <br /> --------__----------__--_ ---------------- This Permit Expires 1 Year from Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install J the work herein <br /> described. This application is made in compliance with County Ordin n No. 549 and exist' Rules d,le dations: <br /> JOB ADDRESS/LOCATION i�e4/ _ =--- -.--- EN US R CT _.___�__:�j_...-------- <br /> r <br /> Owner's Name t --------------------------------A-- - Phone.._____ _ <br /> Cifi p <br /> Address Y �• h <br /> -------Li�nse # .� / ---- Phone `tiC_�Ei_ _r�-- <br /> Contractor's Name ------ - ---- N <br /> inwill serve: Residence E] Apartment House❑ Commer�c� <br /> Motel$Other a1 :❑Trailer Court ❑+ <br /> t __ -'; <br /> - p?`Q <br /> ,,Number of living units_._____-___ Number of bedrooms ____________Garbage Grinder _______.____ Lot Size _ __ ___________________-__--__ _____ ---- <br /> .Water Supply: Public System and name ----------------------------- ---------------------------------------------.----------------------------------•-Private <br /> iCharacter of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;❑ <br /> - <br /> Hardpan Adobe F1 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.) A <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if ublicfsewer is available within 200 feet,) <br /> "�•* V <br /> F .PACKAGE TREATMENT [ ] SEPTIC TANK Siz -_-- - ---- _� '---F------ Liquid Dept}i,--•- -------•-------- <br /> - No. Comportments �` ....--..A.. <br /> p� Capacity eao---- --- Type u--- Material� 1_�'_ t t <br /> = Distance to nearest: Wel! -__-- ----------------------Foundation.�d_-_-.__._-___ Prop. Line _� __ <br /> } �` <br /> a LEACHING LINE [ No. of Lines -------/------------- Length of eac, line------ --:------------ Total�Lengthhs---------.----•----------- I <br /> 'D' Box ________-- Type Filter Material �_ A�-lbepth Filter Material_ _____________ ___________________ <br /> Distance to nearest: Well _ _ - -------p-- Foundation __ -- --- -- Property Line -f- 'rte` °-- <br /> r SEEPAGE PIT -� Diameter _3�-------- Number ________. _----_-_'---- Rock Filled Yes <br /> Water Table Depth ---- i -----------r--- E ockSize <br /> �" t <br /> }'# oun ation - ine ` a <br /> DistaZ�i <br /> to nearest: W - <br /> (Prev. Sonion Permit# -------_----------------- <br /> tDate ------�-`------- --------------- <br /> REPAIR/ADDITION1 <br /> Septic Tank (Specify Requirements) ------_______________ _ <br /> Disposal Field (Specify Requirements) ------------- ------•-----------•--------------- <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 wits► 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 "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 bec su jeat to $rk 's Compensation laws of California." <br /> o- Signed __ � -- - -- <br /> -------------------------------- Owner <br /> • ----------------- Title -------------------------------------------------- -------- <br /> ----------- <br /> (If other than owner) <br /> PARTMENT USE ONLY rhy <br /> ` ----------------- DATE -, 4-ler---- ��---------------- <br /> APPLICATIONACCEPTED BY -------- - ----- - -- --- ----- --------------------------------------------------------- <br /> PERMITISSUED ------ --- -- -- -- --------------------------------------------=--------------DATE ------------- -------- ----- -------------- <br /> A ITIONA COMMENTS -------- --- ----- r <br /> ------ h ��� fir_ ;�n� ------ = r � <br /> 4 f a.s� <br /> 7 <br /> �. --------- - <br /> "` = ------------- ate -- <br /> Inspection by: s------------ i --------------------- ------------------ Date 40- <br /> Final <br /> - N QUIN 'LOCAL HEALTH DISTRICT <br /> t E. H. 9 1-'68 Rev. 5M <br />