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t <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> �J�� <br /> ----------- ' Permit No,. _;� ---- <br /> - <br /> --------------- <br /> -------- <br /> I y s �, �. Date Issued �d� 3 <br /> --------------- This Permit Expires;]_Year From.Date;lssued <br /> -------------- <br /> Application is hereby made to the San Joaquin Local Health District .for.' a permit to construct and instal!thework herein <br /> described. This application is made in compliance with County Ordinance No.,549 a d existing Rules and Regulations: <br /> f . r <br /> w F ! <br /> � <br /> � <br /> CEN.S'US TRACT --------------------------- <br /> JOB / <br /> ADDRESS/LO TION -------- -------- ` - PoneZ ---Owner's Name ------- ----- <br /> --------------------------- <br /> - f ----- --------------------------=----•--- <br /> - --- ------- <br /> Address ---------------- - -------------- - --- -- -- _ - -C' Y <br /> _ _----- .License # YPhone <br /> Contactor s Name - ------------ ----------------- ---- 1L}- <br /> Installation will serve: Residence Apartment House❑ Commercibl ❑Trailer Court ',❑ E <br /> Motel ❑Other ----___ t <br /> ---------- <br /> Number of living units:---1_------- Number of bedrooms---- Grinder ------------ Lot Size _--_ ___- p✓�J_ -------- <br /> i Water Supply: Public System and name --------------------------------Z-,------------------ -------------------:------------------------------Private ❑ <br /> Character of soil to a depth_of 3'feet:"Sand'❑ Silt-El- Clay El--Peat El Sandy-Loam ❑ "Cloy Loam ❑ <br /> Hardpan©--yAdobeII-Material-2----- ---- If•yes;type d 7 <br /> i (Plot plan, showing size of lot, location of system in relation" to wells, buildings, etc. must be plated�an_�reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitte'd.if public sewer is available within 200 feet,) "1 k <br /> t PACKAGE TREATMENT [ ] SEPTIC TANK;( ] `' � Size---------------- ------------------------------- Liquid Depth -------------------------- <br /> ..� <br /> I Capacity Type ---- -- Material__ � _ �No. Compartments --------_---- •--•--� . <br /> Distance to nearest::Well ___________________'-----___ _Foundationw ___ - .______ Prop. Line _____.._____ __..-.- <br /> LEACHING LINE No. of Lines ------- ___________ Length of each line----le� ___ Total Length ---/f.G__=____.____ <br /> / _____.Depth Filter Material <br /> i 'D' 13ax ----1------ Type Filter Material - ----�-- � ------/-- ------•------------�-�--- ,� <br /> I � � � <br /> Distance to nearest: Well .------- _-- --- Found-cobra -=---- --------------"Properfiy�Llrte _- ----------- <br /> SEEPAGE PIT Depth- ----- ©iometer --__ Number -----------/------------- Rock Filled Yes a' No .CJ <br /> ____Rock Size __ _ / <br /> Water Table,Depth - t----------------- z-------------=-- - --�------------------_ <br /> Tel <br /> y Distance to nearest: Well ----- --_f_---.______#-----Foundation <br /> Prop. Line '_ <br /> f <br /> REPAIR./ DDITION.(Prev. Sanitation Permit# ------ •--------------------- -- /D'ate --- -------- <br /> Septic <br /> -- I. <br /> Septic Tank (Specify Requirements)' -------- -�--r; C-,_ ' __. \- <br /> _ ' -..------E-------------------- <br /> Disposal Field (Specify Requirements)'- ----------e---��...---- `' —-----------[------------------- <br /> lr : 4 F -------------------------------------------------� <br /> #+ { <br /> ----------------- <br /> ------ ----------- - ! <br /> s � s <br /> --------------- <br /> --- - - <br /> r (Draw existing and required addition on reverse side) .� <br /> I hereby certify that, 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 Work <br /> man's Compensation laws of California.'.' <br /> Signed ----------------- --------------/--{(-------------------------------- _---------------------- Owner,—. <br /> Title C�---�-, <br /> (If <br /> other than owner) , <br /> s <br /> ( <br /> FOR DEPARTMENT USE ONLY <br /> ' 1 ; a � r <br /> APPLICATION ACCEPTED BY = --------------- - - --------- DATEti-.r'- - . <br /> BUILDING; PERMIT ISSUED - ------------°------------------------ - DATE .: <br /> ADDITIONAL—CO]+�MENTS "_ i------------- ------------- ------------------- -- --------------------------------------- ------------------­----------- <br /> ------------- -` <br /> - ------------------------------------ - <br /> -- -- ---- -------- <br /> -------------`-- <br /> ---------------------------------------- _ � ' <br /> - --------------------- ------- ----- -----------• ----------- -Y-- -- -- Date - -=-- r <br /> Final Inspection bY- - ----- ;------ ---------: -- <br /> ---- ---------------------- <br /> i JOAQUIN LOCAL HE LTH DI RICT <br /> E. H. 9 1-'68 Rev. 5M i ' �' <br />