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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT _c� <br /> -- ��------------------------------ Permit No. -73---L3 <br /> (Complete in Triplicate) - .. <br /> ----_---------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued l°-dt3-73 <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 .-------. fr5W_ _ --- p-----------------CENSUS TRACT - -`--•----------- <br /> Owner's Name ------------------C:_-F1ZP 5--------------------- ----------•------------------------------ --------------- -Phone <br /> Address -------- ---------------------------------��------------------------------------------------•--• City -- cA------------------------------------------------------- <br /> Contractor's Name ----------------------C-XV.1!„Q!a„---------------------------------------------.License # ---------:-------------- Phone ------------------------------ <br /> Installation will serve: Residence ❑Apartment House❑ Commercial :❑Trailer Court ;❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:__..-_1_-- Number of bedrooms ---,..3------ Grinder _.-. _._ Lot Size ________-.__-_____________________________ <br /> Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ 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 [ ] Size----------------------•------------------------- Liquid Depth -------------------------- <br /> Capacity -- ----------------- Type -------------------- Material---------------------- No. Compartments ---------.... <br /> ......_. Dr <br /> Distance to nearest: Well ____________________________________Foundation ---------------------- Prop. Line .__________________.__� <br /> LEACHING LINE= [ ] No. of Lines _----------- Length of each line --------------------------- Total Length _____-____--___--_--__._.__ <br /> 'D' Box ------------ Type Filter Material ____________________Depth Filter Material ---__._______________-.-_____________-____-_ <br /> Distance to nearest: Well _______________________ Foundation ------------------------ Property Line _-______-______.__._---- , <br /> SEEPAGE PIT [ ] Depth ------____---------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No Cl 7 <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest. Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- 2 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) 7 <br /> Septic Tank (Specify Requirements) - - __ar---fit-1me- '.../90-------------------------------------..--_----------------------------- <br /> Disposal Field (Specify Requirements) -----------•------------------------------------------------------------------------------------------------------------------------- <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, i shall not employ any person in such manner . <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed �------------- -- --- <br /> ------------------------------------ Owner <br /> Byt �� ----------------------------- Title ---- <br /> ----- ----- ---------------------------- --------------------------- <br /> (If of er than ownerFOR DEPARTMENT LIAE ONLY <br /> APPLICATION ACCEPTED 8Y -----------------------------C - --- --- ---- ------- DATE / ='T --------------------- <br /> BUILDING PERMIT ISSUED - ---------------------------------- DATEADDITIONAL COMMENTS ------------------ ----------------------- ------ - <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------ <br /> --------------- ------------------------------------ - ------------- <br /> --------------- -------------------------- -- ------------- <br /> --- ----- - - - - - -- -- -----=------- <br /> --- ---- ---- --- -- --- <br /> Final Inspection by- ---------------------------------- --------------------------------- ------ - -- -------------- <br /> ---------- Date' ------------- <br /> SAN JOAQUIN LOCAL H DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />