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FOR OFFICE USE: JJ <br /> APPLICATION FOR SANITATION PERMIT <br /> . ... .-, -c�............................... 31?- <br /> (Complete in Triplicate) Permit No. ..7,.�-.......... . <br /> ....................................... �3-73 <br /> A --.• .................. This Permit Expires II Year From Date Issued Date Issued ..........._.._...:. <br /> Application is hereby made to th Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is ma ori compliance with County .Ordinance No. 644 and existing Rules and Regulations- <br /> I , <br /> ON` c. 1. �... �1 ,�%rr-_. '%�,r.� .-.' � , f EN JS TRACT ..----------•- ....... <br /> Owner's Name�. ..=-J-h4..... ��... C:. �.�:�--...---- •---- m......Phone ......w......................... ! <br /> s�, " try � ` '................. city �� <br /> Address �. .....:....:.� <br /> Contractor's Name ........� / .. �� License #-°Klh . ' Phone ..............:..:. <br /> -�. � 1 <br /> Installation will serve: Residence [7 artment House C] Commercial ❑Trailer Court 0 <br /> ' ... Motel-❑Other• .......................i................. <br /> Number of Living units:..--.--. Number of b ams rbage Grinder Lot Size �/.`�: ..,............... <br /> t <br /> Water-Supply: Public System and name t... _--:� '.��'�•---� �-�.. ...•.-..... . .........................Private [3 <br /> Character of soil to a depth of 3 feet: Sand[] : Silt❑ Clay ❑ Peat'[] Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑. Adobe Oo-OFiil Material 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 se tic tank or seeps pit permitted if public sewer is available within 200 feet,} <br /> �_- <br /> PACKAGE TREATMENT SEPTIC TANK ze. __ <br /> [ Liquid Depth . �-.,_._.. <br /> -- <br /> 1.. <br /> •---��.�-- Type .� . _ . ..__ Material _.-,O;na Vo. Compartments --:---••-__-... <br /> Capacity ' <br /> Di .ce 'to' nearest: Well --ll - ...... ...........Foundation �................. Prop. Line .c' ....... J) <br /> LEACHING LINE [4-- No. of Lines _.. _____________ Le gth -leach line-/OV .-.--.---.-. Total Length <br /> -............ a <br /> 'D' Box - Type Filter Material QX ,.....Depth Filter Material .......11.fV_. .,........:.....:... <br /> a Distance to nearest: Well .. ....... Foundation /_�-�-._.-..... Property Line ?. ............... <br /> l` . �,�; i� <br /> SEEPAGE PITS [I,JDepth .. * .--_-_-! Diameter :. ..... Number ...../--------------------- Rock Filled Yes UE No ❑ I I <br /> Water Table Depth ....... ! Rock Size .., .. ....... <br /> . AR. <br /> ii Distance to nearest: Well ­­, .f` ...............Foundation AR f......... Prop. Line ��_ ._.._.--..._.... <br /> - i � <br /> REPAIR/ADDITION(Prev. Sanitation Permit##--------...-................................ Date -_-_----......_........ .......... C` <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) ..................... .. ._....... ............. <br /> I <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 ---- ----------------------------------- --._. -:...r.. 1, -_........:._..._._ Owner <br /> � . 0.................. <br /> Title . <br /> SY ............................ ... .. F <br /> (If other than o r) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .A . ......................................... ... DATE __...6. 313---.............. <br /> BUILDING PERMIT ISSUED ...:. DATE ..................... :... .............. <br /> ADDITIONALCOMMENTS .............................:....•--..._._..--•-•-----..............:..------------........------------------------------...­­1 ........ ---­----•--' <br /> .................•-.. .. .......................................... <br /> ------------------•............................................................................................................................:......................-........................ .......... <br /> FinalInspection :. .... . .. . ....::.::....... ..:.:.::..:..........:...............................-.......................Date ..................... <br /> JOAQUINtLOCAL­HEALTH DISTRICT f <br /> c u 13 24 1-'AQ De., aiu. 7/72 3 P I <br />