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FOR OFFICE USE: <br /> APPLICA,TION-TOR SANITATION PERMIT <br /> -- ------------------------------------------------- Permit No. d- ,5Z <br /> (Complete in Triplicate) <br /> --------------- This Permit Expires 1 Year From Date Issued Date Issued _2.-W-70 <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 --- ------ a CENSUS TRACT ------------ ---------- <br /> Owner's Name lllall `-----------�f--e- �� - Phone <br /> ---------------------- <br /> Address ------- - z-tel --- --- - ------------------------- City <br /> Contractor's Name -----------License #f� ,__day___ Phone ._______________ <br /> --- <br /> Installation will serve: Residence Apartment House-[] Commercial ❑Trailer Court <br /> Motel ❑ Other - -21�- -- --- --- ---- ---- <br /> Number of living units:----- --.- Number of bedrooms -__,i....Garbage Grinder ------------ Lot Size ____________________________________________ <br /> Water Supply: Public System and name -------------------------------------------------------------------------------------- —---------Private <br /> RK- <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ElPeat E] [7 Sandy Loom Iay 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- <br /> { l [ -1. ��--'�--'r--------------- Liquid Depth _. <br /> Capacity -� ��- Type � �------- Material--- No. Compartments ----1" _.._ 00 <br /> Distance to nearest: Well ---------�G---------------------Foundation ----/-o------------- Prop. Line -___---�__�_ e <br /> ------ V) <br /> LEACHING LINE [+]� No. of Lines ----- _____________ Length of each line______J9V_/__-__--_-- Total Length ___leo_`___-_--_--_-_ <br /> 'D' Box -.------_ Type Filter Material ------4.2_t-__Depth Filter Material ------J-'-)_"_._......_.. -------------- <br /> Distance to nearest: Well ________-V©__r------ Foundation --------L_E3_r-------- Property Line ----S................. <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0Water Table Depth -----------------------------------•-- ----•----Rock Size ---- ----------------------•- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _--_------_.____------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -__-_-__-_--_----_--___-_____-_-_-1 <br /> Septic Tank (Specify Requirements) ---------- --------------------- ---------------------------•- . <br /> 00 <br /> Disposal Field (Specify Requirements) --_-_--_-__ <br /> ------------------------------------------------------------------------------------- <br /> _____________________________________ <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ r <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-"toman's Compensation laws of California." <br /> Signed --- ------ --- OwnerBY ---- ---- ------ Title . . - <br /> ----------------- - - -- --- ------- ------------- ------------ <br /> --------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------------------------------------------------- DATE __2"�7- . .............. <br />` BUILDING PERMIT ISSUED -------------------------------------------------- -------------- ---------------------- ----- --------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS -- ------------------------------------------------------------------------------- -------------------------------------=---------------- -------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --- - - ------ <br /> ------------------------------------------------------ -------►-------------------------------------------------------------------------------------------------------------------- -- -- - -------- <br /> -- --- --------------- -- ------------------------------- ------- ----- <br /> Final Inspection b Date D <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />