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?%M urrict k=1 <br /> APPLICATION FOR SANITATION PERMIT <br /> .. .......................................... (Complete In Triplicate) Permit No. .7�.:G , <br /> .. :. <br /> ......................................................... This Permit Expires 1 Year From Date Issued Date Issued .�....... <br /> Application is hereby evade to the San Joaquin Local Health District for a permit to Construct and Install the work herein <br /> described. This application Is made'ln compliance with County Ordinance No: 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LOCATION <br /> q .....1��0.....�.r,....,t��,�fwzo.��........................................ ....CENSUS TRACT .......................... <br /> Owner's Name .......�d.�4 �� ... . � �P.icl .................... ... ...................................Phone ........ <br /> Address .............. ... ....---•......_....--------...........................--••--..City ....414CZka................................................... <br /> Contractor's Name ...4 ....L..q ......License # ..A P%Z,7Z.... Phone .-Y436-24-a—.- <br /> Installation <br /> `434 .-_._• <br /> Installation will serve, Residence P Apartment House f] Commercial❑Trallor Court ❑ <br /> Motel❑Other............................................ <br /> Number of living units:....../... Number of bedrooms .,......Garbage Grinder .. t/m.. Lot SIz��)...e&KA- ace- - <br /> Water Supply, Public System and name -.-.....:Cq_6_".4xC-4. .....................................................................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam P day Loam 0 n . <br /> Hardpan❑ Adobe❑ Fill Material ............ If yea.type............... ............ `1` �' <br /> (Plot pian, showing size of lot, location of system in relatlon to walls, buildings, etc. must be plated an reverse side.) <br /> NEW INSTALLATIONe (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,} <br /> PACKAGE TREATMENT I ) SEPTIC TANK( I Size................................................ Liquid Depth .......................... <br /> Capacity .................... Type .............. Material...................... No. Compartments ..................... <br /> Distance to nearest: Well' .Foundation .......... Prop. Line <br /> - LEACHING LINE No. of Lines .. Length of each line.....................I....... Total Length ............................ • <br /> 'D' Box ............ Type Filter Material ............. . ..Depth Filter Material ............................................ <br /> Distance tQ nearest: Well ........................ foundation ........................ Property Lina ....................... <br /> SEEPAGE PIT f ) Depth ..................... Diameter .-------------- Number ............................ Rock Filled Yes ❑ No Q <br /> Water Table Depth ................................................Rock Size ............. .................. <br /> Distance to nearest, Well ........................................Foundation .................... Prop. Line ..................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit . .......................................... Dgie .................................. <br /> ) <br /> Septic Tank (Specify Requirements) ...... .............. <br /> DisposalField (Specify Requirements) ...................................................................................................................................... <br /> .................. ....................... .......... . ...._...........__..._..._..................... ............................................................................................ <br /> . . <br /> (Draw existing and required addition on reverse tide) <br /> I .hereby certify that 1 have prepared this application and that the work will he done In accordance with Son Joaquin <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Hence owner at liana <br /> sed agents signature terrifies the fallowing: <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 subj <br /> 50 to Workman's Comp nsattows of California." <br /> Signed ._... _. ........................... Owner <br /> By ...................... ...._...................I... ......................--- ........... xitle ........................................................................ <br /> If other than owner <br /> FOR DEPART MWT, LY <br /> APPLICATION ACCEPTED BY ......................................... ................. :.... DATE .....T` �:�.:.............: : <br /> BUILDING PERMIT ISSUED ...... . ........... .....DATE .._....__.._............................... <br /> --•••.............. <br /> ADDITIONALCOMMENTS .......... ...................................................._................_.._...._.........._.__..:............_.............. <br /> ...................................................................... ......................... ------ .................................... <br /> ............................... ............................•----................_......--------•-------........... ...........:.:. <br /> Final inspection by: ._..---......_.._....__ .. i .....Date ... .Gj!7.�.......................... <br /> EH 13 24 1-68 3tQrr. M <br /> a SAN JOAQUIN LOCAL HEALTH DISTRICT 8f711 3M <br />