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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------------------- ------------- <br /> (Completein Triplicate) Permit No. .--73��"� <br /> ---------------------------------------------------------- <br /> This Permit Expires 1 Year From Date Issued Date Issued - <br /> -- ------ ------------- ------------ <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> -�.7._�.G Pat CENSUS TRACT `S y7 <br /> JOB ADDRESS/LOCATI N �_ ------- -��-- - -- <br /> ---- -- - ----- �--------------------------- ----- 3 <br /> Owner's Name _ � _._-______Phone <br /> Address ----- `� r .,-=��`C'' t�1x-� h ... C1 --------------------------------------------- <br /> Contractor shame _ -s- / C ------License # -1. 3� Phone -------=------------- ------- <br /> Installation will serve. Residence-0 Apartment House,❑ Com r�cial c❑Trailer Court i❑ <br /> Motel ❑ Other --.- _ 7 ' <br /> ff ------------------ <br /> Number of living units:.---I------ Number of bedrooms -- _-Garbage Grinder ------------ Lot Size ___-C '_-_- <br /> Water Supply: Public System and name -------------------------------------- ---------------------------------------------------------------------Pri:vate E <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' Siz -� ------- -- ------- --s�- --.-- Liquid Depth -_-_-_�__-_------ <br /> q <br /> Capacity _ __ (ype - J_-_ Material- �No. Compartments ......_.... <br /> � - Foundation ------1 a---------- Prop. Line ­----------------- <br /> LEACHING <br /> --- --/--- <br /> Distance to near t: Well _____________ __ C <br /> f � <br /> LEACHING LINE [ No. of Lines --------------I_______ Length of each line---------fK42____._-__-_ Total Length -----i!b <br /> 'D' Box _--___- Type Filter Material ----S___2 ----Depth Filter Material ----t<-1--------------------------- -:.--_ <br /> Distance to nearest: Well ------- - -_ Foundation ____--__I'0___ -__-_- Property line ----------- g�. <br /> SEEPAGE PIT [ Depth ......c�. _ JTDiameter Number -------- Rock Filled Yes (2` No C <br /> - -- ------------- ---- -- -- <br /> I l�' <br /> Water Table Depth ------- ----- P-- - -----------Rock Size --- - -X-�-- <br /> Distance to nearest: Well --------LC--_---- -- --------------Foundation ------1-P_V_ Prop. Line -----5_ _-_- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------.--------------) <br /> Septic Tank {Specify Requirements) ------------------- ------------------------------------------------------------------------•-•------------ -------------- <br /> Disposdl 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 ------ --------------- ----6�2 <br /> ----------------------� Owner <br /> BY (---.� J ''= � = Title ---- G �,_�'--= L1-=-------------------- <br /> --------------- <br /> (If other.than owner) <br /> FOR <DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE .-_�. -- -7`3 <br /> BUILDING PERMIT.ISSUED ------------------------------ <br /> -- ------------------------•---------------------------------------DATE ------------------------------------------- <br /> ADDITIONAL <br /> ---------------•--------------• ---- ••--- <br /> ADDITIONALCOMMENTS ------------------------- --------------------------------------------------------------------------- --- ----•---- --------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- <br /> - <br /> ----------------------------------------------------------------------------- <br /> Final Inspection b ---_---.Date --- ---__ <br /> --- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT f <br /> E. H. 9 1-'68 Rev. 5M <br />