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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------------------- <br /> (Complete in Triplicate) Permit No: 7-z--^1--6----1 <br /> --------------------------------------------------------- <br /> `Expires 1 Year From Date Issued Date Issued <br /> ___-__________________________._-_____________ this permit <br /> Application is hereby made to the San Joaq0!n'L-dcaI Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance/mowith County Ordinance <br /> No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION .-- - •- ,------------ --- - j ---------------------------CENSUS TRACT --------------.----------- <br /> �1_ !` y ` q <br /> Owner's Name -------------- -------ts--- -- - --- ------Phone.-q7-( _-_-SC�_1-7�--- <br /> Address :- - -ttT --Me City - ----------------y- ' ----- <br /> 1 Phone 5�6- -- - <br /> Contractor's Name ------------ -------• -- - _ -_:----.License# ��.--- -- - -- �-5'---A-7--•- <br /> Installation will serve: Residence AOa6ment'House,M Commercial :❑Trailer Court <br /> ii Motel F-1Other -------------- -------•--------------------- <br /> Number of living units:---/----.__ Number ofa1 edrooms.r�-3_-__Garbage Grinder`------. -- Lot Size ------ ------------------ <br /> Water Supply: Public System and name ----------------'-----------" " ------------------------------------------------I------------------------------------Private <br /> t <br /> Character of soil to a depth of"3 feet.- Sand'❑ Silt❑ Clay ❑ Peat❑ 41Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ AdobeFill N4at tial __ ' If yes;type --_--.--_---_------------- <br /> k <br /> (Plot plan, showing size dflot,.,location of system 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 /> PACKAGE TREATMENT' [ SEPTIC TANK[ J;. '� Size----------------------------------- ' -- Liquid Depth - <br /> `V <br /> Capacity --------7-------------Type -------------------- Material---------------------- No. Compartments ----------------- Q <br /> Distance to nearest: Well ---------------- ------Foundation ---------------------- Prop. Line ----.-_------------- <br /> LEACHING LINE [ ] No..,of.Lines = :�`'<y_--.-.-- Length of each line---------------------------- Total Length ----------- ---------------- �- <br /> 'D'-Box - -- Type Filter Material --------------------Depth Filter Material ------------------------------------------•- <br /> r -� <br /> Distance.to..nearest:Well---------------------"^':1roundation -------- Property Line _---_--_-_---_---_--._-- <br /> SEEPAGE PIT [ ] Depth ----------- --%_``_= .,Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 <br /> Water Table Depth"I=-----------------------------------------------Rock Size -------------------------------- <br /> r-• Distance to nearest: Well -----------------------------------------Foundation -------------------- Prop. Line ---------------------• <br /> REPAIR/ARDITION(Prev. Sanitation Permit#---'--------------------------------------- Date ----_--_--_--_--_----___----__---} <br /> Septic'Tank (Specify Requirements} -------------------------------- <br /> ---------- <br /> t <br /> i Disposal Field (Specify Requirements) ------- ---------�Q-------------------------------`.' �-"'r---------------------------- <br /> r <br /> ---------------------------- ----------------------- ----------�-------- ` - -X Q " -a--------f_�'-------------------- = <br /> ------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------- ----------- <br /> (Draw existingand 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 /> F "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 /> Signed ---------------------- ------ - -------------------------------------------- Owner <br /> gY - - <br /> Title ---- -- ' <br /> - ----------------------------------------------- <br /> (If of r han owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ _.--__:----------------------------------__. DATE -.-.�__-=2--�- Z-.- <br /> ------------------ ------------------ ---------- <br /> BUILDING PERMIT ISSUED ------ -- <br /> -P-�-"-'-="-"--- <br /> --- <br /> � - -zADDITIONAL COMMENTS - f'� ;'V - <br /> ------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------I------------------------------------------ --------------------------------------'------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------- <br /> -- -------- ----- <br /> -77 ---- •------ <br /> --- -- ---------------------- ------------------ -Z <br /> Final Inspection by: ------ Date 19-�----------------- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5Min <br />