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FOR OFFICE USE: <br /> APPLICATION. FOR SANITATION PERMIT . <br /> (Complete In Triplicate) Permit No. ..................... <br /> ..•................................•...-----•.--•---_-... . This Perini!Expires 1 Year From Date Issued <br /> Date <br /> Application is hereby made to the San Joaquin Local Health District for a permit 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 /> C.. - <br /> JOB ADDRESS/LO ATION .............. ... ...... ......_..}•----- ----...............:.CENSUS TRACT . <br /> ..... .....—....i............................................. <br /> Owner's Name ... ......---•-----------•--......----•-. -•-••... ............•---...................•-----..Phone ..WS--S-----3------ <br /> Address '� � ---•------- <br /> ..............City .............-------......•.........--------------•........_-------------- <br /> Contractor's Name ...-----...... ..... ----------------•----------••-•--.........:..--_...License # ........................ Phone ........................------ <br /> Installation will serve: Residence Q Apartmen _ ousel] Commercial OTrailer Court C] <br /> Motel Other..... ........ G"+� <br /> Number of living units------------- Number of bedrooms ----.. _--Garbage Grinder ........:... Lot Size ...��.-�k��.................. <br /> Water Supply: Public System and name ........................................................—.__....._......_................:...._...:.._._...Private (� <br /> Character of soil to a depth of 3 feet: Sand'[J Silt Clay ❑ Peat❑ Sandy Loam {] clay Loam 0 <br /> Hardpan a Adobe Fill Mater€al ............ €fes <br /> Y ►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 208 feet,) <br /> PACKAGE TREATMENT 1' ] SEPTIC TANK I ....... Liquid Depth 6 <br /> Size..----=---•--•..:::........•----......... ............ <br /> Capacity <br /> Q-- --- Type _. AA.... Material:��.,.. No:"Compartments ..a.............. 0 <br /> Distance to nearest: Well ��------------- ..Foundat€on ... ---------._-. Prop. line . .......... <br /> LEACHING LINE [ ] No. of Lines ---- •-•............... Length of och line......b.....-_-.---:. Total Length ...................._-....,. m <br /> q r� N <br /> 'D' Box ............ Type Filter{Material .. ......_ __--.Depth Filter Material ._'....�...Pr............................. r't <br /> S6EPGIJP ' r r <br /> Distance to nearest: Well ._--�d�...-/`... undation ._.�b............... Property Line G.� ..... 0 <br /> Cj Depth' c ,---•-... Diameter--•---. Number ..........1.s-------_-._ . Rock Filled Yes� No 0 3 <br /> Water Table Depth .... � � t�ii <br /> Rock Size ... <br /> Distance to nearest: Well ....46.00..:......................foundation .-.W? .......... Prop. Line 1 �. <br /> REPAIR/ADDITION(Prev. Sanitation Permit _--_-_---_- Date � <br /> SepticTank (Specify Requirements) --- --------------•-----------.................::•.;-------....._.............--.........-•---•------....---..._,......-------------- <br /> Disposal 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;Dlstrlct. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "1 certif that In the pe once of the work for which this permit is issued, I shall not employ any person in such manna <br /> as to et me subject W rkmpn's Comperesat' laws of California." <br /> Signe '- ------------ - -------- -- -•-•---- Owner <br /> BY ------- ------ ---------------_-_..._.._-_---------- . ------ 3itle --- ---.....----.... . -.--.....- <br /> (lf other than.owner) = _ <br /> FOR PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.----- --- -----• •--- ----- -------- :_:.._: DATE <br /> BUlIfllNG Pi RMIT 155UED - -- ------ -------- .--:DATE _...-----....._...._...--------.__.._...... <br /> ------......... <br /> - - - -- ---- •-------...-- <br /> ADDITIONAL COMMENTS _......... <br /> ----- •----- <br /> ---------------------------------------------------------------*-------- <br /> .---------•--•-------•-•--•----•.--------•........... ................ <br /> .. <br /> ` ._ <br /> Final Inspection by: .. - ---... Date/ j� <br /> Elf 13 24 1-68 Rev. 5m <br /> SAN JOAQUIN LOCA! HEALTH DISTRICT <br /> 8/7h 3M <br /> } <br />