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FOR OFFICE USE: <br /> ' APPLICATION FOR SANITATION PERMIT <br /> II, (Complete in Triplicate) Permit No. 70-_1110 <br /> ----------------_-----------.______---- ---------1I----- This Permit Expires 1 Year From Date Issued Date Issued <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 /> JOB ADDRESS LOCATION .---+ -- � --------------------------------------------CENSUS TRACT _ ---------,___-- <br /> Owner's Name ` ------------------------------ ------------ --------Phone ------------------------------------ <br /> Address ------_1 ----!z!,3 _SII <br /> --------------- City -Alvir = ------------------- <br /> I. <br /> Contractor's NameI, --------------------------------------------------------- ----------License # ------------------------ Phone -------------------•--- <br /> Installation will serve: Residence ❑Apartment House Commercial❑Trailer Court 43 _ <br /> Motel ❑Other ------------- ------------------------------ <br /> Number of living units:________ Number of bedrooms J---------Garbage Grinder --- -------- Lot Size ®_°"_ _____________________ <br /> Water Supply: Public System and name ---------------------- ---------------------------------------------- ---------------------- -----------------Private F-1Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam: <br /> Hardpan ] Adobe ❑ .Fill 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 /> t NEW INSTALLATION: [NIo septic tank or seepage pit permitted <br /> /if public sewer is available within 200 feet,) � 1 <br /> PACKAGE TREATMENT [ SEPTIC TANK; -] Size ------------------------ r � <br /> l - Liquid Depth ----------­-----­-- <br /> Ca <br /> W <br /> C pacity/r7____.,___ Typg� - Material-- __ No. Compartments ________________ <br /> Foundation __. - ` '� <br /> Distance to nearest: Well �------------------------- -&------------_-_ Prop. Line ______---------•__---- <br /> LEACHING LINE Nb, of Lines _._I----------------- Length of each line----/ft-------------- Total Length/ _______. ---________ <br /> DBos _______ Type Filter Materia! ________Depth Filter Material __ -------------_______ <br /> Distance to nearest: Well _ '�__--------------- <br /> ___________ __ Foundation 4 Property�- r <br /> - - ------------•-- -- Pro a Line :�-------•----------- <br /> ( SEEPAGE PIT Diameter <br /> F <br /> D�pth _-- - __-.--- Number --�'"-------------------- Rock Filled Yes , No i0 <br /> I Wi ter Table Depth _?A---------------------------------------Rock Size �yc --�- - V <br /> - ----- ----- <br /> Distance to nearest: Well/P-V__-_______________--________Foundation /�_____.____ Prop. Line --•------------- <br /> ' I! <br /> REPAIR/ADDITION(Prev. Snitation Permit# -----•-•------------------------------------ Date ----------------_--.-.-----------_] r <br /> SepticTank (Specify Rejuirements) ---------------------------------------------------------------------------------------------:---------------- ._---------------- <br /> ---------- <br /> Disposal Field (Specify, Requirements) --------------------------------------------------------------------------------------------------------------------- ---•----------- <br /> --------------------- <br /> ------------------------- ----------------' ------------- --------------------------------------------------------------------------------------------------------------------------------------------- <br /> t _ i (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 /> t' "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 /> Cs to be a subject to Workman's Compensation laws of California." <br /> s ,rp t <br /> Signed C^- ZJ <br /> t-._ - ----------------------------- Owner <br /> By ------------ ------------------ -=I�- ------------- ------------ -------- Title ----------------' <br /> (If other than owner) <br /> - - -------- - ------------------------------------------- <br /> I: FOR DEPARTMENT US7L------ <br /> Y <br /> APPLICATION ACCEPTED BY -- ----------- -- --------- -- -----------. DATE _� <br /> i BUILDING PERMIT ISSUED{'---- ---------------- DATE <br /> --------------------------------------------------------- ---------- ......... <br /> ADDITIONAL COMMENTS a______________________ _ <br /> - --------------- <br /> ------------- - <br /> ------------------------------------- <br /> --------------------------------------------------------------------------------------------- -- <br /> --- - ----------------------- <br /> Fi�nal Inspection by- ------------`r-------------------------------------------------------------------------------------------------------- --- - - - --------------------- <br /> Date ------------ <br /> I <br /> - SAN JOAQUIN LOCAL HEALTH DISTRICT ' <br /> E. H. 9 1-'68 Rev, 5M i <br />