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FOR OFFIGE USE: <br /> �. APPLICATION FOR SANITATION PERMIT <br /> .................. Permit No: o <br /> (Complete in Triplicate) <br /> ---------=----------------------------------------------- <br /> Date issued _c;2-._&h6_Z9 <br /> ----------------------------------------- <br /> --- This PermitExpires 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 /> CAy� l�-:�JOB ADDRESS/LOCATIION .---/�W�----v, -`_ --- ------ ---------------------CENSUS TRACT -----/ --------------- <br /> - <br /> ---q- - - <br /> Owner's Name '� -- <br /> ----------------------------=- . ------. - __ ---_ <br /> Address - <br /> 4 <br /> off - 1 --- -------- --. City. <br /> Contractor's Name ; �-�License # 4 - f 7- _ Phone -j <br /> - - -- - --------- <br /> Installation will serve: ResidenceXApartment House�❑ Commercial ❑Trailer Court ;❑ <br /> / Motel ❑ Other -------------------------------------------- <br /> Number of living units------ Number of bedro s _____Gar�age G Inde ________._ t Size __ � 3/0_____________ <br /> Water Supply: Public System and name -------------- -:---_-- . -_ ---------Private ❑ <br /> Character of soil to a depth of,3 feet:_ Sand'E] Silt❑,�.,_ Clay _❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan [❑ Adobe Fill Material ------------ If yes, type ----------------- <br /> ----------- <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. f ] SEPTIC TANK'[ ] � Size------------------------------------------------ Liquid Depth -------------------------- <br /> r ,.i � <br /> Capacity ----------------- Type ----------I--------- Material---------------------- No. Compartments -------.._-........... t <br /> t � ,f` <br /> Distance to nearest: Well -----_-----#------------------------Foundation ---------------------- Prop. Line ------------------- <br /> LEACHING LINE [ ] No. -of,Lin& , <br /> s ------------------------ Length of each line---------------------------- Total Length -----------,___.______ -•-- \' , <br /> 'D' Box _________`Type Filter Material ____________________Depth Filter Material ----------------------------1............. <br /> ._. <br /> Distance to nearest: Well --------------'--------- Foundation ------------------------ Property Line ._______.. ............. <br /> « `SEEPAGE PIT Depth ____________________ Diameter ---------------- )Number ---------------------------- Rock Filled Yes ❑ No i❑ <br /> WaterTable Depth ------------------------------------------------Rock Size ------------------------------- <br /> . ---==--Distance to nearest: Well----------- _______________________Foundation -------------------- Prop. Line ________________.___.. <br /> Se tic Tank (Specify Requirements) Date ) <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------- ----- <br /> P { p Y q ) - ------------------------ -- ---- <br /> _/ - -- ------ ' <br /> Di posal Field (Spec; Requirements) ' ` . ------------- - - - -------- --------- --. -- - ------------ <br /> = ----------- <br /> -- ---- ----- -- <br /> � ., � <br /> �- = - ---- -0------------------------- <br /> ,�... . , ,..» —..- (Draw existing and required addition on re rse side) <br /> 1 hereby certify`that I have prepared'this application and that the work will-be done in accordance with San Joaquin <br /> County Ordin nc@S,,,State Laws;and Rules and Regulations of they San Joaquin local Health District. Home owner or Hcen- <br /> sed agents signature certifies the following: 1 <br /> "I certify that in the performance o the work for ich this permit is issued, I shall not employ any person in such manner <br /> as to be gree s bject tb o km Comperisati sof California." E <br /> Signed -- -i--=# �- w � -- C/ i-- - -- ----------- Owner <br /> " 1 _ti <br /> - <br /> (If n owner) <br /> TMENT USE ONLY r <br /> APPLICATION ACCEPTED BY - - _ DATE �.- - _7Y-------------- <br /> BUILDING PERMIT ISSUED --------- ---- -- --- -------------------------------------------------------DATE- ----- <br /> ADDITIONALCOMMENTS ------- --- ------ ----- - ------ - ------------------------------------------ ----------------------- ------------------------------------ ------- <br /> 1. <br /> - <br /> °�- -------------- --- ---- <br /> -- --------- ---- ---{_ �- -- ---------------- ------------ -- --------------------------------------------------------------------------- <br /> -------------------------------- ---------- F <br /> - <br /> - --- ----------------------------------------------------------------------------------- --------------- <br /> Final Inspection by: ------ - - - -------- =-- _� ` <br /> ---------------------------- Qate - <br /> 4J'^N JOAQUIN-LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />