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FOR OFFJCE USE: <br /> r APPLICATION FOR SANITATION PERMIT <br /> ................. ........ ............................. Y Permit No.7 :7Z-019.. <br /> (Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued Dote 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 <br /> AA No. 5.49 and existing Rules and Regulations: <br /> JOB ADDRESS LOCATION � .�� .,.,.. C{ �1'� I`�. CENSUS TRACT <br /> Cdr !� 't................. . ....•........... ......... <br /> Owner's Name .........---- � .. -►........_...---•-- ----------------•-•----...--•-----•----............._...._...................Phone ......... .......................... <br /> Address . --------- -- .......... <br /> . <br /> _ ...----._.. _ ._.__..._.•-----•--•--_........_......City ..,........_......•.-... - --- <br /> Contractor's Name _`��. X0 , 4 ------ ..........................License # 7Z.'8rS.J.C_..... Phone ._ 7z,61U....-_. <br /> Installation will serve: Residence©'Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel0 Other....................... .................... <br /> Number of living units:--- ........ Number of bedrooms 3.......Garbage Grinder ............ Lot Size _.-1..arex.......................... <br /> Water Supply: Public System and name ------------------ ......................................................... ................................Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay a Peat❑ Sandy Loom 0 Clay Loam ❑ <br /> Hardpan C] Adobe 0 Fill Material ............ If yes, type ............... ............ <br /> (Blot pian, showing size of lot, location-bf 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.---••.......................................... Liquid Depth ...._..................... ;..I <br /> —• .,.-- <br /> Capacity -.- ---------,.,.:TYPe _ Material..................... <br /> No. Compartments ...................... <br /> Distance to nearest: Well Length-af • •• Foundation ..�2_ .. .__ Prop. Line ..., ?. . ..... <br /> LEACHING LINE [ ] No. of Lines __..._ each Iine...g0_V. Total Length . <br /> •---- <br /> .. � Type Fit .......... ........ <br /> 'D' Sox ._._ yp ter Material .� _�� _ :.Depth Filter-Material ._. �' ............... .................. <br /> Distance to nearest: Weil ---/20. Xj <br /> : Foundation --- Property Line `,�. ¢...._.. <br /> SEEPAGE PIT [ 3 Depth ----------------_- Diameter __..._......_". Number ............................ Rock Filled Yes ❑ No G <br /> �... Water Table Depth ................................................Rock Size ......_,........................ <br /> Distance to nearest: Well ........................................Foundation ..._......... ...... Prop. Line ...................... <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ------------------------------------ Date ............................... <br /> Septic Tank (Specify Requirementsl ---:::=-•••............................................:....•=-••.......----------•----._.._.............._.......-----•-----------•---•--• <br /> Disposal Field (Specify .Requirements) --------•--•------ ---------------------• -----------.........----••....-----------•.--•..... --•---••--- <br /> ----------------------------------- ------ ...................__................................................................................_....................................................... <br /> --------------•-------------------•-------------- ------------•• ---••------------------------------------------.......................................................•.................. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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. Horne owner or licew <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 -------------•----------------- Owner <br /> BYk. ._ ----------------------------------------------------- Title _. /1'!4'14-- .................. <br /> (If other than owder) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ ._.. -------- --------------- DATE .. J._ ..,...,_,.....-.�_:. <br /> BUILDINGPERMIT ISSUED -------•---------- .....•-•-••----------------.....---------- --------•------------•---------•----DATE ........ ---------....-- <br /> ADDITIONAL COMME=NTS -------•--•--------------------•- <br /> ...............• ---- <br /> --------------------------- - ----- _._ ..-- ........ <br /> Final Inspection by: -•--- --- - --------- -----••-- Date ........ <br /> EH 13 2t{ 1-613 v. ._. ' <br /> AN JOAQUIN LOCAL HEALTH DISTRICT 8/71, 3M <br />