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-FdZ OFFICE USE: <br /> APPLICATION FOR SANITATION PE1t1111lT - <br /> .. ................ (Complete In Triplicate) a Permit No. ..7.6_' 36 ,. <br /> -----•-•-------•-••...................................... This Permit Expires t Year From Date Issued <br /> Do Issued ._ .... :7� <br /> E 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 complian a with Coun Ordinance No 549 and existing Rules and Regulations: <br /> JOB ADDRESSAOCAT N .._� 7 /�s` <br /> �?�`� r'�` - CENSUS TRACT <br /> ........................ <br /> Owner's Name .... .. -�� one <br /> �.�4 _Address ....:Ci <br /> --------------- <br /> Contractor's Name --...••-•......... License # . .......... Phoned !6 <br /> - <br /> Installation will serve: Residence House 0 OTraifer Court 0 <br /> Motel 0 Other•• . ..:.. ..... <br /> Number of living units:-------.f- Number of bedrooms :.Garbage Grinder ............ tot Size ----1�_� .............. <br /> Water Supply: Public System and name ------•------------ .......................................................................................Private . <br /> Character of soil to a depth of 3 feet: Sand L] Silt 0 Gay 0 . Peat 0 Sandy Loam 0 Clay loam <br /> Hardpan 0 Adobe• Fill Material ............If yes,type............... ...... } <br /> (Plot plan, showing size of lot, location of system in relation 'towells,'buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage-pit-permitted if public sewer is available within 240 feet)" <br /> �� <br /> PACKAGE TREATMENT Capacity EPTIC TANK�� :ze.__ ? :_._.___ .. -------------- Liquid Depth - _..___.._- <br /> I TYPE <br /> ---. - _ Ma#er€ai. I.��.�c•�.._ No. Compartments _.�.......�...i , <br /> Distance.to nearest: Well _. OP.f......................:.Foundation ...1�r.......... Prop. Line ._. ........... <br /> LEACHING LINE 1>1, No. of Lines __-I—! •_ Length of each kine--- _'....... ... Total Length .........4.40-0........Ur <br /> 'D' Box ............. Type Filter•Materiot Depth Filter Material ........................ <br /> Distance to nearest: Well ....... Foundation .... ......_.. Property Line .... <br /> SEEPAGE PIT � Depth Dep Diameter�� ��rt Number �... .... Rock Filled Yes No C <br /> - Water .Table Depth -------�f-...............Rock Size ......------------1�--•---•- N ; <br /> _ <br /> Distance to nearest: Well ........................................Foundation ..................... Prop. Line ---_-----_--_--_- <br /> r REPAIR/ADDITION(Prev. Sanitation Permit,# ................................. Date <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) J.---------------------- -- ....•-•-• -------------..._....-- -•-•--••••------•-•-•-......---•-- •-----•-•-------- <br /> ------------------------------------ <br /> ------------------------------------------------------------------•-------------------•-----• ----•-----•-------------------- -.......... .................. <br /> ---------------_ ------------------------ -•------------------------•-------------------------------•--------... --••-----••-•--------•-••-•-••.......•••..... ......... <br /> (Draw existing and required addition on.reverse side( <br /> I :hereby certify that 1 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 Haalth:District. Homs 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 WA-rkmaos Compensatia laws of alifornia." <br /> Signed ' •.....___ <br /> -------------- <br /> C�wner- <br /> BY -•-•---------- -----}- ...-----------.. __-• -----• Title ..... -.. . ---------.......----•-....__.._._.- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ ....... --. DATE ._.. '..,._... <br /> BUILDING PERMIT ISSUED ------------- ------ ---........................................... - ._...DATE -------- ................................ <br /> ADDITIONAL COMMENTS ------•-------- ................------------------................... ......_.: <br /> ------ <br /> r <br /> --------- ------------------ --------------•-•---- -•--- ...---------•---• ----.._. ............ <br /> --- ---- -- ------- --- <br /> ............. ........................... ------ --- -- ---• --- <br /> Final Inspection by: ..- ----------------------------------------------------------- ------Date � -"�..� -7­ _... <br /> EH 13 2h 1`68 I °• SAN JOAQUIN LOCAL. HEALTH DISTRICT 8/7h 3M <br />