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{ _FOR OFFICE USE: <br /> .................................................... <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit W. 2t�—��..... <br /> I (complete In Triplicate] . <br /> ....... ...:..............:..................'--.. _ <br /> ............ This Perm It Expires 3 Year from Date Issued Date Issued .�...�67.. <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 ptgt]eincog� an�eith u y Ord nce No 49 and existing Rules and Regulations: <br /> I K <br /> i JOB ADDRESS/LOCATION .......... CENSUS TRACT <br /> _ <br /> Owner's Name _ <br /> : ' <br /> M - <br /> ' .Phone <br /> Address #City � <br /> . .�........................ <br /> License <br /> Contractor's•Name .- . . <br /> Phone g%2 ,/66 <br /> Installation will serve: r '; Residence irtment.House.cl Commercial❑Trailer Court i❑ <br /> 1. Motel ❑Other �cQ,iN,G__��JPctI,4G4 <br /> Number of livingunits: Number of a rooms ._ <br /> Garbage Grinder ------------ Lot Size ._.- .................... <br /> �P Wate,Supply: Public System and name - - r va - <br /> = ..........................•-------------- ....... == _ p i <br /> ---------- to <br /> Character of soil to a depth of 31eet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> x Hardpan IV Adobe❑ Fill Material if yes,type <br /> (Plot plan, showing size of lot, 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 I ] Size.--- .�r ���............... ........ Liquid Depth ---------............. <br /> Capacity --:.-............... Type _1'.[i4..... Material.�C/� No. Compartments ...L <br /> ............... <br /> Distance to nearest: Well -----------_.. Foundation .--_ ----------------- Prop.-Line .. <br /> LEACHING LINE [ ] No. of Lines .- -•. .............. Length of a ch line....:.....�Q........ Total Len�thh ,. ..._. .-- -�y <br /> 'D' Box . -......_ Type Filter Material -- . -------Depth Filter Material ........................ ... <br /> Distance to nearest: Well ............. Foundation .... Pro ........................ <br /> `s� r-------�- .................... party L e <br /> � n <br /> [ ] Depth �0- ... • ' X ..... Number .. I................... Rock Filled Yes No CV <br /> Water Table Depth .............------------- .................Rock Size -=-�/lca-...i -`i 0 <br /> Distance <br /> to nearest: Well ....................... Foundation -•...................Prop. Line .............. n" <br /> REPAIR/ADDITION(Prev.. Sanitation ;Permit# ............................................ Date .................................. <br /> Septic Tank (Specify Requirements) ••-----•------......................................................................... <br /> a - <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 Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hanle owner or licen- <br /> sed agents signotu ifies a lowing: <br /> "1 certify that t e pe r ance f the work for'which this permit is Issued, I shall not employ any person in such manner <br /> as to beco e s act tokma ' Compens n laws of California." t <br /> Signe ... <br /> -- --------- ------ ---- •-•---------- Owner <br /> BY • ------ <br /> . title A <br /> kl_ <br /> �-®•................................... <br /> • (If other than owner) ........ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---•- .....----•---:--...----•...... ...................... ............. ........ DATE._.....- .:.-. - <br /> BUILDING .PERMIT ISSUED ------------- <br /> -------------------- <br /> .----------------- .....---•----... ...-..DATE ---- ------..-....... .................... <br /> ADDITIONAL COMMENTS .. <br /> ..................... .......... .................................. <br /> -------------------------------------------- --m-----------------------I........... ------------ ......................... .......... <br /> ............. <br /> .-- ----- <br /> Finalinspection 6Y: --- r-- - .......Date . -..��. . <br /> EN <br /> 13 24 1-68, 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />