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FOR OFFICE USE. w _ <br /> :w- <br /> b ���° _ 3 APPLICATION FOR SANITATION PERMIT <br /> Permit No: <br /> (Complete in Triplicate) <br /> i Date Issued <br /> } _________________ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit tc 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 .._ ___. ✓ L_�r __-______.__ __ ._ ..CENSUS TRACT __. <br /> . <br /> Owner's Name ._ f r -- -- --- -- -- --- ------ <br /> ------------ --�7-?'�'�--_--------- --- _ Phone ',�'�-� ,� �,- <br /> Address --------- �/� /l/ .Sf ' �" -- - --- City ---------------------` ` `- ------------------------------------------------- <br /> Contractor's <br /> ---------- -- --- --- -••----- <br /> _.Contractor's Name -- •4 ' r � _ License,# _r'✓'f"` `_^% Phone <br /> "_ <br /> k Installation will serve: Residence PN-Apartment•House,j] Commercial :❑Trailer Court ;Q <br /> F <br /> Motel F-1 Other --------------------------------------------- <br /> Number <br /> -------------- -----------------=--- -----Number of living units:._ ____ Number of bedrooms ,-_Garbage Grinder--4-0._--Lot-Size•_ _- .X1( _Z?_ ----------- <br /> - r <br /> Water Supply: Public System and name -------------- ------ -------- ---------------------------------------------------------------------------1 Private ❑ <br /> i t <br /> Character of soil to a depth of 3 feet: Sand;- Silt Flay 0 Peat ❑ Sandy Loam "❑ Clay Loam .0 <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type --------- __-.____I-________ <br /> (Pl'ot, plan, showing size,6f.lot, 1ocation 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,) s <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-------------------------------- Liquid DeptF-------------'---:----_.-..- r <br /> Capacity -------------------- Type -------------------- Material--------------------- No.­C6mpartments ............... <br /> t --.-.___-____-----__- Prop Distance to nearest: Well ---------------------------•---_--- Foundation . Line ---•-.--•----'--____-- <br /> LEACHING LINE [ I No. of Lines ----------------------- Length of each line------------------- Total Length --_-_--_-----__-.----.._-_._ <br /> I 'D' Box ---- -- --- Type Filter Material ----_____-______--Depth Filter Material -,---._ <br /> ------------- ------------- <br /> Distance to nearest: Well ___.__ _- c:_Foundation. _: ,Pro a Line <br /> _. - p r --- <br /> --- <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter _____:___-_-.-_- Number --------..____--_--------_-- Rock Filled Yes '[)^ No ❑ <br /> Water Table Depth --------------- --------------------------------Rock Size - ------------------------------ <br /> Distance to nearest: Well ----------------------------------------Foundation -------------- ---- Prop. Line --------------........ _ <br /> REPAIR/ADDITION(Prev. Sanitation Permit ______________ Date :_______________________ __ } <br /> f - <br /> Septic Tank (Specify Requirements)}---- vvl --�----- <br /> - <br /> r_[: Gl.r 7�7 <br /> w / <br /> , ------- <br /> ' <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 1n 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 /> 1 "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. mans Comppnsation laws of California." <br /> Signed r� _.�.:- <br /> �.. a -------------------------------------------- Owner <br /> By =---------------------------------------------- --------------------------------------------------- Title --------------------------------------------------- -------------------- <br /> (If other than owner) <br /> FOR .D PANTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------------------- ------------------ -- ------- ---- DATE ...._.'=r`�,'? ------------ <br /> BUILDING PERMIT ISSUED --------------------------- ---------------------- DATE -:.--------------•----------------------•--- <br /> ADDITIONAL COMMENTS - - <br /> F <br /> f --'"-----------------`------------ --------------------------------------------------------------------.--------------------- ---------------_-----------_------------------------------------------ <br /> __________________________________ ____ __ ____ __-----.__--------_-_-___--_-.---____-__-----____---__--„--_-------.__-.-________----_-_._____---_------______._ <br /> FinalInspection by: -- - -- �-------------------------- -------- -----------------------------•-------------------------------.Date <br /> -JOA UI LOCAL HEALTH" DISTRICT <br /> -'8-` .N. <br /> E. H. 9 1-'68 Rev. 5M. .� <br />