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FOR OFFICE USE: <br /> f- ` -- —APPLICATION FOR SANITATION PERMIT, <br /> 7 U / Perm it No. 1Q <br /> - ..._ <br /> (Complete in Triplicate) _ <br /> ----------_--- , Date Issued -- -.� <br /> This Permit Expires 1 Year From Date Issued <br /> Local Health'District for a permit to construct and install the work herein <br /> Application is hereby made to the San Joaquin <br /> described. This application-is made in compliance with Co my Ordinance No. 549 and existing Rules and Regulations: <br /> 'J �y f - --------------- <br /> JOB ADDRESS/LOCATION �l �-/- -=---- --------- <br /> Owner's <br /> ----- , ' ------------ CENSUS TRACT <br /> A' ,? --- --------Phone ------.. <br /> Owner's Name --���"-r��-----------U--Q�,rr�-----------••----------�-----------------• - - - <br /> Address ------------ ----------- City <br /> �1�7- ------------------------------ <br /> Contractor's Name -- _ _ 5--- cf License # ,�7 �� Phone : ..---- <br /> __ <br /> Installation will serve: Residence EdApartrnent House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other --------------------------------------- -- A / ; <br /> F Number of living units.----- Number of bedrooms -___---Garbage Grinder _ _ _!�_._ Lot Size _ <br /> Water Supply: Public System and name ----------------------- ---------------------------------------- • ---•------ .-Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'E] Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.0 <br /> l Hardpan ❑ Adobe [,/Fil[ 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 fgll Size----------------------------------- -- - Liquid Depth -----------------•---.----- <br /> ----------------- Material_-_C--__----.----- No. Compartments <br /> Distance to nearest: Well -------------------=----------------Foundation ---------------------- Prop. Line ----------•----------- ` <br /> LEACHING LINE [ ] No. of Lines -----------.------------- Length of each line---------------------------- Total Length ,---------------- <br /> l �1 <br /> ` 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------­----- ----------------- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line •-----------------•----- <br /> SEEPAGE PIT { Depth ----------- <br /> _ Diameter ____ Number _------------- ------------ Rock Filled Yes Q No YQ <br /> Water-Table Depth --------------- <br /> -------Rock Size -------------- -------------•-- <br /> Distance to nearest: Well _________________________________ -• <br /> k -------Foundation -------------- ---- Prop. Line --------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit F# __________________________________ <br /> ------ Date ------ --------------------------- <br /> Septic Tank (Specify Requirements) ---- --------- ----- -- ----- -- -- ------------------------------.-------------------- <br /> Disposal <br /> -------------------Dis osal Field (Specify Requirements) _ _ /9.4 <br /> � ` x -33" � <br /> ---------------------------------------------------------------------------------------------------- <br /> f ------------- ------------------------------ -- ' ---------------------------------------------------------------------------------------------- <br /> (Drawexisting and req---red adclition 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 /> r as to become subject to Wor an' Compe tion laws of California." <br /> Signed ------------- Owner <br /> --------------- Title ------------------ ------------- ------------- -------------------- <br /> (If other than owner) <br /> FOR EPARTMENT USE ONLY <br /> APPLICATION ACCE=PTED'BY ---- ---- ------------ ------ -- ----------------------------- <br /> -------- DATE.__ _-----_`_-2_ <br /> BUILDING PERMIT ISSUED DAT <br /> --------- --------- - <br /> ► AD ITIO AL CO ENS __?L ------------ <br /> ------- --- - -------- - <br /> -------------------- <br /> ----- ---------------------------- ------------- <br /> -- ------ <br /> - ----------- ----- --- ---- - ------ - - <br /> ---------------------------- ----- - - <br /> I Final Inspection b Date _'�^_-- -'---`�---------------• <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M, <br />