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FOR OFFICE USE: <br /> I 'APPLICATION FOR SANITATION PERMIT' <br /> .. _� . __ ,-_ ._ (Com plete.in.Tr.iplicote) .._.� .,_ <br /> ' s Permit No: .7_ <br /> ---------------------------------------------------------- <br /> I Date Issued __�-�-"t ` 7/ ' <br /> - _�_______ This Permit Expires 1 Year From Date Issued -------- <br /> Application is hereby mad o 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 .___-- -1-- 7.__1__--:--- - ------J4 rt---_- ,- -----------CENSUS TRACT --------- <br /> Owner's Name ----------------- ----------------��1/ I-'4p � ---------------Phone.-�4 9-7-�--&�'3----- <br /> Address ._`- --,. L -1---------------- CitY <br /> t Contractor's Name ----_---_-- G -- --5$" —--------------------------------License # r -SCS_....... Phone <br /> F Installation will serve: Residence Apartment House ❑ Commercial ❑Trailer Court <br /> Motel ❑ Other -------------- -- - �- --------- <br /> ' 1 <br /> Number of living units:_________ Number of bedrooms __'- _,_Garbage Orinder __-___ Lot Size ---- ____O____________ <br /> Water Supply: Public System and name ------------------------------ ------------`J---------- u-"------------------Private ❑ <br /> i Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat E�-' Sandy Loam Clay Loam ❑ <br /> Hardpan ❑ `-)Adobe' Fill Material If yes, type ____________________________ <br /> (Plot plan, showing size of lot, Location of system in relation 4o wells, buildings, etc. must ,be placed on reverse side.) <br /> c <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted'ifiipublic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT, [ J SEPTIC TANK Siie______4 __, -- -____________________ Liquid Depth ---_S "------------- <br /> :-A <br /> Ca acity teril --------------------- <br /> PTYp - aaC,j . <br /> --- � - t <br /> Distance to nedreft:,„Well ______________ _________________ *:Foundation __/0___-___.____. Prop. line ___. __________- <br /> I z.- , n <br /> LEACHING LINE No. of Lines -- ��'_____ia. , LengthV 4- _df each line_______� _e-___.._-__ Total Length __/7Q__�______-____ <br /> .,.�. 'D' Box -----�� Yp ' (- -- -----Depth Filter�afieri Pro-1-k---� e ---�-"�•-------- <br /> f T e Filter Material"""_ _ <br /> Distance to nearest. Well -----------------. _ _ Foundation p Property L' r <br /> SEEPAGE PIT j Depth. i��Y ________ Diameter _- -Nr Number -------.'Y---------- Rock Filled Yes)` No ❑ <br /> 'i t( , <br /> Water Table Depth ----------1----------------- -=--- --------Rock Size - --- �---r-------------•---- <br /> Distance to nearest: Well _________________ ____________Foundation --------------..---- Prop. Line ________________.___. <br /> REPAIR ADDITION(Prev. Sanitation Permit s# -----.__------------------------------------ Date ---,________._____________________) <br /> SepticTank (Specify Requirements) ------------------------------------------------- ------ ------------------------------- --------------------•---------------------- ----- <br /> 1 <br /> Disposal Field (Specify Requirements) -----------_------- _____________ _____ <br /> -- ---------------------------------------------- --------------- ----------------------------------------------------- ------------------------- <br /> --------------------------------------------------- - <br /> q <br /> ` t S <br /> ---------- ,,.�: �.-�-c----------------- -----•-------------------------------------------- <br /> (Draw existing and required addition on reverse`sldeW <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 become subject to Workman's Compensation laws of California." : <br /> ' Signed - ------ -1� r <br /> Owner r <br /> By ----------- ------------------------------------ Title --- -------------- -------- ----------------------- <br /> ----- -- - <br /> ( n owner) , <br /> ,FOR,.DEPART'M!15NT US£ ONLY <br /> APPLICATION ACCEPTED BY ------ -�tvM- ------ - ------------------------------. DATE t 'a - <br /> BUILDING PERMIT ISSUED ----- -- -------------------------------- --------------------I---------------------------------------DATE ------------ ------------------------------ <br /> ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------------------------------------- -------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Final Inspection b : __ - - - - pa -- ♦`IRA-------------- <br /> - -- - <br /> p Y ------ -------------------------------------- D <br /> ----- ------- to - o -. �_ ..------- ----- <br /> SAN JOAQUIN LOCM HEALTH ISTRICT <br /> f <br /> E. H. 9 1-'68 Rev. 5M <br />