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FOR OFFICE USE: <br /> c APPLICATION FOR SANIT#TION PERMIT a <br /> Permit No.,7 J'� 7 <br /> --------------------------------------------------------- __ _ _ <br /> --------- ----------------------------------------------- 1 <br /> (Complete in`Triplicate) • .. <br /> Date Issued �._.�_7-3 <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 existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .______1 ._ a .........E_.__.._ _-_- 71�-r�,�l--___-----CENSUS TRACT __________________________ <br /> Owner's Name -------j_z>_t-A------�'-- r �� r �� --- --------------- ---Phone ------------------------------------ <br /> 141V_ -5 <br /> Address ----- ---- ------ -------��GIC�U. itY ----- -------------• - - <br /> -- -- -• ----------•------ <br /> Contractor's Name --------5_ - `- -------------------------------------------------------License # --------- -------------- Phone <br /> Installation will serve: Residence`RApartment House❑ Commercial ❑Trailer Court i❑ <br /> Motel ❑Other ......... <br /> ----- t---------- ----------------- <br /> Number of living units:-----i------ Number of bedrooms ......Garbage Grinder ------------ Lot Size _ __��� -- <br /> `- -_____________ <br /> Water Supply: Public System and name _-__1it!_-u_�------------------------------------------------------------------------------------------.Private ❑ <br /> Character of soil to a depth of 3 feet: Sand[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe I 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 TANKA Size____��OL� --------------- Liquid Depth -____-________-_-_.--__ <br /> - ----------------- -- <br /> Capacity,/Z00_ . __._. Type ____________________ Material_ -r No. Compartments _...�r................. <br /> Distance to nearest: Well __ ---_f__"----._______________Foundation ---- -------- Prop. Line-, <br /> c G� d <br /> LEACHING LINE [ ] No. of Lines __ _______________ Length of each line___._-1.-47------------- Total Length ,_____. __..__._______._.._ <br /> 'D' Box ------------ Type Filter Material ____________________Depth Filter Material -------------------------------------------- <br /> UV <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ........................ <br /> SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes 'Q No �J <br /> Water Table Depth ------------------------------------------------Rock Size --------•-•-----------------•--- <br /> Distance to nearest: Well ----------------------------------------Foundation ----- -------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ___-._--_________________ ........ <br /> Septic Tank (Specify Requirements) --------------------- -------------------------------------------- ------------------ -------- ----- ---- <br /> �(`� - c <br /> Disposal Field (Specify Requirements) ----la�- `r- �.... X <br /> C -e ---- ---- <br /> - - <br /> --- ------------ ---------------- ------------------------------- -- - <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 certif at int performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to eco a su ct to ork an's ompensation laws of California." <br /> Signe - ------ ----- ---------------------------------------- Owner <br /> By - ---- ----------------------------------------------------------------------------------------------- Title ------------------------------------------------------------ <br /> (If other than owner) <br /> FRP DEPARTM§4T USE ONLY .y } <br /> APPLICATION ACCEPTED BY L�11 - ------------------- DATE -----/= 7_/___3------ <br /> BUILDING PERMIT ISSUED _------------------ - -----------------------------------DATE ----------------------------------------- <br /> ADDITIONALCOMMENTS -----------------------------------------------------------_--------------------- -----------------------------------------—------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------- ------------------- ------------------------------------------------------------------------------------------------------- <br /> ------------------------------------ --- ---------- - ----- -- -- ------------------- `---------------------------------------------- ---------------- _ �y -- ---------------- <br /> �-1 <br /> Final Inspection by: --------------------------------------------------------Date __ _. _ _ "".._ ____________________ <br /> SAN JOA QU11El LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />