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3(' 77 <br /> APPLICATION FOR SANITATION PERMIT <br /> FOR OFFICE"is,: ~" <br /> J / Permit No. r-� r <br /> �� <br /> --- - (Complete in Triplicate) <br /> --3a�9 <br /> ------�--------------------------------- - ---- � 00 Date Issued ._�-_.Z�_�. � <br /> �i This Permit Expires 1 Year From Date Issued <br /> ---------------------- ------------ -- <br /> A lication 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 my Ordin nce No. 549 and existing Rules and Regulations: <br /> k I <br /> 3-1--------- -------- --- <br /> CENSUS TRACT <br /> JOB ADDRESS/LOCATIO --. <br /> --------- --- <br /> Oddness Name ._____-. � <br /> Phone '- ------ <br /> ------------------------------------------- <br /> * �` ------------------- �7 S-- - City <br /> t <br /> _.License # -------- -------------- Phone _ = <br /> ----- <br /> Qx�Contractor's Name ---- ---- -- - ---- / j <br /> Installation will serve: .^�- Residence)(Apartment House.'❑ Commercial,:❑Trailer,Court i❑ <br /> t • . <br /> ''Motel ❑Other ------------- ------------------------------- <br /> Number of living units.-JI-1 <br /> ' ----. Number _ _of bedrooms ----- -_ arbage Grinder -----,---.._ Lot Size ---------------------------------------------- <br /> System and-name ----------------- -----------------------------------------------f—�-;--------------------------- Private ❑ <br /> Water Supply: Public S st <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Pe afi ❑Sandy Loam ❑ Clay Loam <br /> i pi! mn � Adobe ❑ Fill Material ------------ If yes,type ___________________________ <br /> HarcI- a ❑ <br /> P <br /> -(Plot plan, showing size of lot, location of-syst6r in relation to wells buildings, etc. must be placed on reverse side.) <br /> [ NEW INSTALLATION: {No septic tank or.seepage pit permitted if public sewer is:available within 200 feet,} <br /> ��s til <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'( ] Siz*e'__ ------------------------------- Liquid Depth --------- ---------- <br /> Capacity ---- --------- - Type'-T�----------------- MaWrial_------------------- No. Compartments -------------•-------- <br /> 0 i. a <br /> Distance to nearest: Well ------------------------------- Fo und 6 tio n------------------ --- Prop. Line --------------- <br /> LEACHING LINE [ J No. of Lines __-- ------------- -- Length of each line------------------------ -- Total Length ------.__..------------ <br /> `D' Box- n: --=Type Filter Material -------------�----Depth Filter Material ------ -----------A-- ------------•----•- <br /> -Distance to nearest: Well ----------- =--- Foundation ---------a-.-------_---- Property Line ------------------------ <br /> x <br /> SEEPAGE PIT ( ] IDepth *`_- Diameter ___-_--_-_ -- Number -_._------- '------'-'-.- Rock Filled Yes ❑ No '❑ <br /> iWater Table Depth ----------------------------------------------- Rock Size -------------------------------- <br /> Distance to nearest: Well --------------------- I------Foundation -------------------- Prop. Line _---------- - ------ <br /> P <br /> Date ------- } --------------- <br /> REPAIR/ADDITION(Prev.�Sarift—a­­Ko—n Perm_•t_# --------- --Septic Tank (Specify Requirements) ----------- ------- -- ---- <br /> lq ------------- - - l <br /> -' <br /> (SPeciY equ Xemen DiP sal Fie fR ---- ------------ -- <br /> .- - -- --- ---- -- --- ------=-A-------------=-------------------------- ----------------------------------i -- ; ie){Draw existing and required addition onsreverse sd <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 /> h <br /> Signed ----- ---- --------- �--•----- - - ----------------------------------- Owner <br /> ------ Title ---------- -- ---- ---------------`- <br /> BY --- --- - - <br /> ¢ <br /> (If than owner) <br /> j� FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- ----- --- ---- ----------- -- RATE -.__ '__--- ------•` <br /> ------------ - <br /> r ---- <br /> BUILDING PERMIT ISSUED -_ G6_ -- --� � <br /> ADD Tl N L CO MENTS <br /> p- .cam <br /> 'I---- ------------------- --------------------------------�_----�s----�---- ---------------------------------------------------------------------- <br /> �I __ _ ------ --- <br /> -------------------------------- ------------- - - <br /> rv� <br /> Final Inspection b i �,Q Date -------?-l ='=- -------- <br /> �I SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> it <br /> E. H. 9 1-'68 Rev. 5M <br />