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FOR OFFICE USE: APPLICATION• FOR -SANITATION PERMIT <br /> ----------------------------------- Permit No. ----7 �` <br /> 3-9 <br /> (Complete in Triplicate) ! <br /> ___ __________ --__-_-__-----_-,__- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to th San Joaquin Local Health District for a per 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 /> 1!2-r(-o e0a 14 1, 4 u er,< <br /> JOB ADDRESS/LOCATIO US TRACT <br /> Owner's Name G ^--*L'►- �a ----- ----Phone " d_-.-------- <br /> Address --------------- __. City - -- - --------------------------------------- ...... <br /> - _q r� <br /> Contractor's Name ----- -License #� �� Phone 51-4-/_. f ------ <br /> Installation will serve: Residence ❑ Apartment H u e�❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other ----C; ----- <br /> -�E��*-�t��- <br /> 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'o Silt 0 Clay ❑ Petit Sandy Loam Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Materiar.__-_ ------- If yes, type --------_------_____________ <br /> _ <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,J <br /> t )f <br /> PACKAGE TREATMENT [ I SEPTIC TANKize��__ .I_J.t"_______________________________ Liquid Depth -_._ -------------- <br /> CapacityIb� . __ __ Type __ ___ MaterialNo. Compartments ---- ....... . <br /> i <br /> 57 Distance to nearest: Well ------- ----fi---------------Foundation _________ Prop. Line ___ <br /> LEACHINGS [ I No. of Lines _______________________ Length of each line---------------------------- Total Length -------7a------- <br /> ..-.-- <br /> E_Vr r 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------------------------- <br /> _ q.0 Distance to nearest: Well ------------------------ Foundation --------------__-------- Property Line ______________-------- <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 --------------------_-------------) 'h <br /> SepticTank (Specify Requirements) ----------------------------------------------------------------------------------•--------- -------------- .-----------------------..._ <br /> DisposalField (Specify Requirements) ---------------------------------------------------------------------------------------------------------------------•--------------- <br /> -------------------------------------------------------------------------------------•-- . . --------- ` <br /> ------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------- <br /> (Draw <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 --------- ------- Owner <br /> Title ------- [ <br /> By ------------ -- - ------ - --- -------- 16"t <br /> (If of r han owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ _-- ------------------- --- ------------------------------------------------------- DATE -------�31_ <br /> BUILDINGPERMIT ISSUED -------- ----------------------------------- - --------------------------------------------=--------------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS -------------- - ------------------ ------------------------------------ --------------------------- <br /> --------------------------- ----------------------- --------------------------- <br /> L. <br /> ------------------ <br /> ------------ ----------------------------------------------------- <br /> -------------------------------------------------------- ------ <br /> ­­ <br /> - ------------------------------- ------ --- ---------- ------------------------------------------ <br /> ---------- ------------------- -- --- <br /> --------------------------------------------- --------- - - -- ---- - - ---- <br /> Final Inspection by- ---- --------------•---------------------------------------Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H, 9 1-'68 Rev. 5M <br />