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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -------- 3--- --------------- -- Permit No:t-7Z: 3 5 . <br /> (Complete in Triplicate) <br /> ------------------------------------ This Permit Expires 1 Year From Date Issued 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 .....2_ - � �____- �Ca------------------------------CENSUS TRACpT ----- -c�.----------- <br /> Owner's Name ---------------------- _� C2T-L'/ G --------------------------------------------------------Phone ----0�-:5 ..---- <br /> Address ----- ----------- 9�_-�11_(-------S------LOt ----kWqt,U--------- City -.55A<,`T---------------------- <br /> \- , <br /> Contractor's Name --------------------- License # Phone �'"- <br /> ��_C�1 �L. -------------------- -- <br /> r <br /> Installation will serve: :Residence Apartment House❑ Commercial ;❑Trailer Court [I <br /> Motel ❑Other --------- --------------------------------- <br /> Number of living units:-----/____ Number of bedrooms --- -------Garbage Grinder ___' Lot Size _-jdd_X_____2__ 8_____________ <br /> Water Supply: Public System and name ----- ------------- -------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet:F Sand❑ Silt[-14 Cla" ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe -`Fill Material -.---------- If yes,type ---------------------------- <br /> (Plot plan, showing.size iof.lot,0ocation_of-system..infrelation t wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: [No septic tank or seepage p permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ } SEPTIC TANK:�< Size---^L�-.:l94V_6CLL------I-.-- ----- Liquid Depth <br /> = ° . .- <br /> --�z _____________ <br /> No. Compartments ------- <br /> CapacityType MaterialClr <br /> = <br /> Distance to nearest: Well _______' _ _____________________Foundation -----fU-----------.Prop. Line ------ <br /> LEACHING LINE [ ] No. of Lines -----:3-- L ngth of each line-----=k P____`-___.------ Total Length -------------- <br /> C <br /> l4 ' <br /> `D' Box ---IAS--_ Type Filter Material !zoe-----Depth Filter Material ____-____1_� . <br /> �r --------------------------------- <br /> Distance'to'nearest: Well ____lvf Jt�i--__-__--__.-Foundation _.- `.-.__._.._- Property Line_ -----5 -------------- <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ------------- ------ ----.- Rock Filled Yes ❑ No I❑ <br /> Water Table Depth --------------------------------------- -----..Rock Size -------------- <br /> Distance to nearest. Well -----------------------------------------Foundation -------------------- Prop. Line _________-_________-_. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date -------------_____________________) <br /> SepticTank {Specify Requirements} ------------------------------------------------------------------------------- ------------------------------.---------------------------- <br /> Disposal Field (Specify Requirements) ----------- ---------------------------------------------------------- --------------------------------------------------------- <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 be a subject to Work 'syComoensation aws of California." <br /> Signed -- ----- -- C-�/ - e------------------- Owner <br /> BY -------------- --- -----------------------------=------------------------------------------------------ Title - --------- <br /> --------------------------------------------------- <br /> (If other than owner) <br /> FOR DEPA1tTMEN USE NLY <br /> APPLICATION ACCEPTED BY ---------------- ---------r-- -------- -------- DATE ------------ ---------------- <br /> BUILDINGPERMIT -ISSUED ---------------------------------------- ----------- --- ------ -- --- --- ---- --------------DATE ----------------- ----------------- ------- <br /> ADDITIONAL COMMENTS ---------------------------------------- <br /> --------------I------------------------------------ <br /> ------------------------------------- <br /> ------------------------------6 N------------------ <br /> ----------------------------------------------------------------------------- --------------------------------------- <br /> FinalInspection by-- -----------------------------= - ----------------------------------------=------------ pate �� ----------------------- <br /> 'AN <br /> r <br /> SAN JOAQUIN LOCAL MEAL iSTRICT <br /> E. H. 9 1-'b8 Rev. 5M. .. <br />