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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------------------------- - Permit No. _703-"/6--6 2=. <br /> (Complete in Triplicate) <br /> ---------------------------------------------------------- <br /> Date Issued --b= .' - <br /> -------------------------------------.-------------------- This Permit Expires 1 Year From 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 existin Rules and Regulations: t <br /> 9 O W PeCZA <br /> -` <br /> JOB ADDRESS/LOCATION -_- --- - -�''[--�� -- '-`` -CE SU5 TRACT_--------•---- •--•-------- <br /> Owner's Name - "--- -'-- --- -- --------- -------- --- - - - -- ----- --------------------------- Phone'--'--------------------------------- <br /> Address � Zt CitY � � <br /> ------- - ---- ---7 <br /> Contractor's Name _____________�___ ------.License # --- Phone <br /> Phone <br /> ------�-- <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ',❑ <br /> Motel ❑ Other ------------------------------------------ <br /> Number of living units:-----(--- Number of bedrooms ---�---Garbage Grinder ------------ Lot Size ----- `ems----------------- <br /> Water Supply: Public System and,name ----- ---- ------------------= ==-- __ Private --*-•.- .`I <br /> '4 <br /> r.Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ l <br /> Hardpan'❑ Adobe <br /> Fill Material -----.------- If yes, type ---------------------------- 11 a <br /> (Plot plan, showing size of lot, locatior�of system in relation to wells, buildings, etc, must be placed on reverse side.}_ <br /> NEW-. <br /> NSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'f I Size------------------------------------------------ Liquid Depth ------------------:-:----- � <br /> R Capacity ----=---------- -- Type -------------------- Material---------------------- No. Compartments ------ ------ <br /> "r. Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -------- --,------ <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line-------------- ------ ------ Total Length <br /> N- <br /> 'D' -Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------------------------- , <br /> Distance to nearest: Well ------------------------ Foundation _______-___-_r--_---- Property Line. ------------------------- <br /> SEEPAGE PIT [ ] Depth ----- ----------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No 0 <br /> r. .. . Water Table` Depth_:-�-'----------------------------------------------------------Roc Size--------------------------------- <br /> Distance <br /> - ------------------------ <br /> Distance to,nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------- Date.---------------------------------- <br /> Septic <br /> -------__---_--__----_-----------Se tic Tank (Specify Requirements) ----_r --- - -- •--- ----- - ----- -----'--- -------•.----- ---- <br /> Disposal Field (Specify Requirements) ------------ -GG---- 6 "�-��`' <br /> ,---- - I — - = - ------------------------ <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, 1 shall not employ any person in such manner <br /> as to become subject to Wor an's Compensation laws of California." <br /> j <br /> Signed -- -- ---Alo <br /> ---' ----------------------------- Owner <br /> - --- --------- Title ---- 1 <br /> er t n wner) <br /> FOR DEPARTMENT USE ONLY �7 <br /> APPLICATION ACCEP ED Y _--- -- z- ------------------------------- DATE ---- -C:------1 -"'-�- - <br /> BUILDING PERMIT ISS ED -------------- ---------------------------------------- -- DATE - <br /> -- <br /> ADDITIONALCOMMENTS ----------------------------------------------------------- --------------------------------------- ------------------ ----------------------------------------- <br /> ----------------------------------------------------------------------------------------=----------------------------------------------------------------------------------------------------------------- <br /> ------------- <br /> ---------------------------------------- <br /> ---------------------- --------------------------------------------------------------- <br /> '---------------------- ----------- ---a- ------•----------------- <br /> Final Inspection by: --•------------------------------------------=--------------- -4A7 -----------Date --%� = 7z- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />