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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -Triplicate) ' <br /> ----------------- --------- (Complete in Permit.No.2C�1? <br /> --------------------------------------------- I ThIsTermit Expires I Year From Date Issued 3. Date Issued <br /> Application is hereby made to the'San Joaquin Local Health District for a permit to constrtje�and'install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules,and Regulations. <br /> -,�-t (7 12 ZMA ---- <br /> JOB ADDRESS/LOCATION --- - - -------- ------7f 7 -�Oilf�-_._CENSUS TRACT ------------------_2' <br /> Phone ------------------------------------ <br /> -—------------ ------------_- <br /> Owner's Name =------ ---------- City ---6"Z�lv <br /> Address ---- ------------------- -- ---- 0 - ---------------------------- <br /> -----------Sle_-j------.License #14� D--fFQ-Ph---- ----- -------------- --------- <br /> Contractor's Name --- ----- <br /> Installation will serve.. Residence 21(partment House[] Commercial .[:]Trailer Court f:1 <br /> Motel El Other -------------------------------------------- <br /> V--&5 /P <br /> - - ------ <br /> _ Lot Size - ---adl <br /> Number of living units: ---- Number of bedrooms ----Garbage Grinder 17 <br /> Water Supply. Public System and name ------------------------------ ---------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet. Sand[] Silt C1 Clay [-] Peat[-I Sandy Loam 0 Clay Loam 0 <br /> Hardpan ❑ Adobe 2__ Material If yes,type ---------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc,., mpst 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)o Ze-------- 4saLiquid Depth __ZW`­/­�--------- <br /> U6 _.��__ o rt --- ........ <br /> -,e a�, . Compo' ments <br /> Capacity Type _P "_yyMatericil -IxC __ <br /> ---------- Prop. Line ---IS—_----------- <br /> Distance to nearest. Well -----6--v- --------------------Foundation <br /> LE.ACHING LINE [4 No. of Lines --.a--------------- Length of each linel 0-V____ <br /> V---- Total Length ............ <br /> 'D' Box e-C J Aa-l' 0--Dept"h 'Filter Material ---- <br /> Type Filter Material __r__ <br /> Material <br /> 14 <br /> Distanceyc ne rest: Well ---45-4?------------ Foundation -------------- Property Line(.24__ .-- ---------- <br /> SEEPAGE PIT Depth ---------- Diameter Z_'�------- Number ------------ Rock Filled Yes 'No C1 <br /> Water Table Depth ----------6--g---------------- ------------Rock Size --- <br /> Distance to nearest. Well -------- .ff-------- .PropLine ___sal.._.......__ <br /> -----------------------Foundation ---)__0 _. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- <br /> Septic Tank {Specify Requirements) -------------------------------------------------------------------------_------------------------------------------­*-------- <br /> Disposal Field (Specify Requirements) ------------I---------------- ------------------------------------------------------------------------------- --------- <br /> -------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- <br /> ----------------------I--------- ---- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required d dclition on reversb-gide) <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. Home owner or licen- <br /> sed agents signature certifies the following-. <br /> "I certify that in the oerFoerfiance 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 /> By -------fl ------------------ -- itle ------------------------------------ <br /> (If other than owner) <br /> R. DEPARTMENT USE ONLY <br /> APPLICATIONX�40 <br /> 1DATE -- <br /> ACCEPTED BY ------------- .,,r ----------------------------------------------------------------------------- - -------------- <br /> BUILDING PERMIT ISSUED ------------------------------------------------------ ------------------------------------=--------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- --------------- <br /> ------------------I----------------------------------- ------------------------------------------------------------------------------------------------------------------------------- <br /> ------ -- ---- -------------- ----- --- <br /> Final Inspection by:---------- V--------------------------------------------------------------------------Date r--- _ - <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />