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FOR OFFICE USE: ? APPLICATION FOR SANITATION PERMIT <br /> f <br /> -------------------- <br /> --------------- Permit No'. <br /> i(Complete in Triplicate) <br /> -------------------- - ------------------------1 :.�, , Date Issued <br /> __-.--- This Permit Expires 1 Year From Bate Issued <br /> Application isohereby made-to.the San{�oaquin Local Health District for a permit to construct and install the work herein <br /> described. This application ris,made incompliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION _� - ------ --- - i CENSUS TRACT -------------------------- <br /> Owner's Name - <br /> ' tar_ s <br /> t. ---- Phoned �' <br /> Address ----- ---- ------------- z` �- - - . ` `� City ------- ------------------------------------------•------ <br /> - -- <br /> Contractor's Name - e�`House Commercial <br /> # er Court Phone - <br /> L-3�f/------ <br /> Installation will serve: Residence ] ❑ ourt l❑ <br /> ! Motel ❑ Other -------------------------------------------- <br /> y 1 <br /> Number of living units:__________ Number of bedroos'-_-----Garbage Grinder _____ ---- Lot Size --------- ----------------- <br /> Water Supply: Public System and name - == a=--------------- .. -----------------------------------------------------'-------------------Private <br /> Character..of.soil to a depth of 3 feet: Sand'❑ ,.j Silt❑ Clay ❑ iPeat❑ Sandy Loam ❑ Clay"Loam <br /> _ - �- �� _ <br /> Hardpani❑, Adobe [] Fill Material __-- It yes, type -------- -------- <br /> (Plot plan, showing; size.`of lot,'locihtion of system in relation. lo wells, buildings, etc. must be placed on reverse side. <br /> NEW INSTALLATION:��. (NN f septic tank or seepage pit permitted-if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT--k{.] SEPTIC TANK , Size--------- _ -______________--_---.__ Liquid Depth ---------------- F <br /> Capacity r <br /> P ty�-� ��- Type -�---- -'------- Material.- No. Compartments ---------------------- 6 <br /> Distance to nearest: Well --------______T_ -------Foundation -----h------------ Prop. Line ._.______ <br /> LEACHING LINE f+ No. of Lines ----------Y____________ Length of each line----L_CYV_............ Total Length .__lam?.__`------------- <br /> 'D' Box ------------ Type Filter Material _fes" -----Depth Filter Material; ----f- ------------------------------•- <br /> Distance to Well _____mW_-'-______ Foundation ---/_.Q---�---_._: Property Line __ _--__ <br /> SEEPAGE PIT [ } Depth _______________'___ Diameter ---------------- Number ----------------- ---------- Rock Filled Yes [] No <br /> Water'TabI '% Deth ------------------------------------------------Rock Size -------------------- ----------- <br /> pt <br /> Distance to neatest: Well ----------------------------------------Foundation -------------------- Prop. Line _______-_____-.---_- <br /> S ____ h <br /> REPAIR/ADDITION(Prev. Sanitation�Permit# ------------------- ----- --------------- Date ---------------.._..--------------) <br /> Septic Tank {Specify Requirements} -------- ---------- --------------------------- ---------------------------•------------------------------ <br /> Disposal Field (Specify Requirements) ---------------------------------------------------- <br /> ----------- ------------ -------------------------------------------------------------- <br /> ----------------------------------------- ------------------------------------------------------ <br /> -------------------------------------------------------- <br /> -------- -------------------- --- <br /> �. _ ....�_. .,ter ...___.. _ - = — .�.. <br /> --- - <br /> (Draw existing and required addition on reverse side) '� r., <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 rhe San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: .� <br /> "1 certify that in the performance of the work for which this permit isiissued, I shall,not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California:" •i.+, <br /> r � � '�'' � ` Owner <br /> Signed ) ---------------------'----------- = v *t <br /> BY ---- ` G ----------- ------------------------------- Title ----------------- -.f.- :---'-------- ------------------------------ <br /> (If er than owner) i - <br /> ! !FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ` DATE -�� -t1aL <br /> r,�___-__-_----.------------------------ <br /> BUILDINGPERMIT ISSUED ------ - ----------------------------------------------------------------------------- -----`-DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS --------------------------------------------------------------------- --------------------------------=t---------------------- ---------------------------- <br /> -------------------------- <br /> --------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> s <br /> --------------------------------------------------------------------------------------------------------- - <br /> --- - -- - - - - -- ------------------------------------------------------------------------------------------------------XSTR <br /> - ----------------=•------ <br /> Final Inspection by: ------ ----------- -- - ---- ------------------------------------------------------ Date `=7 ZSAN JOAQUkN LOCAL HEALTHT <br /> I` E. H. 9 1-'68 Rev. 5M <br />