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FOR OFFICE: USE: <br /> APPLICATION FOR SANITATION PERMIT t <br /> —,(Complete In Triplicate) Permit Na. ..................... } <br /> .................:....:_.:...._........::....: . . - -_ —. mpmp , e e _ _ rr_ <br /> k. .......... This Permit Expires t Year From Date issued <br /> ©ate Issued 7 <br /> ..6. 7 ' <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 ._. 'lr'P'�..--- �� '`.._._ ►i�` Com,- s ............................ TRACT i <br /> Owner's Name .......e,441f.! .1i�1_ ......................................... <br /> .......................•------ •••-----•--..:...._................Phone ........ .......................:.._... `'��N..E' <br /> --•-•-••--------------... ...........-------•-----�-•-----•......................... City ..................__-_._------:....-----. ..._..�.�.. <br /> Contractor's Name --- .. .r_ / �dry?' C. -fir-----&------------__-- --------.License # �:'1�w��`_. Phone <br /> Installation will serve: Residence a Apartment House❑ Commercial❑Trailer Court 0 <br /> P <br /> ' Motel ❑Other --- ----------•--•- <br /> Number of living units:..__ __._.._ Number of bedrooms --- -...Garbage Grinder ------------ Lot Size ...................... <br /> Water Supply; Public System and name ............... .. ! Private er <br /> ......................................M.-_._.--_-----.........__......_.........._ __-._._ <br /> Character of soil to a depth of 3.feet:__Sand... . Silt.— Cla x <br /> P ❑ y-=.0••--Peat-C7--.-Sandy Loam gg Clay Loam ❑ <br /> i Hardpan ❑ ❑ f' <br /> 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 /> NEW INSTALLATION: No septic tank or seepage pit permitted if public sewer is awiiiable'within 200 feet) y <br /> -PACKAGE TREATMENT {� ' J r <br /> ( ] ASEPTIC TANK I ] Size------ -------•-- •-----------•---••--=--------- Liquid Depth ................. <br /> Capacity _f49P�IMOZType A,11!`_<6ArMaterial No'. ;Compartments --�R................J <br /> Distance to nearest: Well /llop--------------------Foundation --___ ------- PrP Line4Aa............ID <br /> LEACHING LINE: [ ] No. of Lines ___..._/..__..__._.. Length of each line.....-tn................ Total Length _,W F.`. <br /> 'D' Boxes_..., Type Filter Material ------Depth Filter Material _.. -•�..._.......................... <br /> Distance to nearest: Well .....4!�q......... Foundation .... Property Line ._:;-a .I.� <br /> -----.... <br /> SEEPAGE .- <br /> 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 ------------------ ] s9 <br /> Septic Tank (Specify Requirements) <br /> ........... ............. .......................................... •--------• •---• <br /> Disposal Field (Specify Requirements) ............. ... . .. <br /> ----- <br /> --------------------------------------•---------------------------------. ......................-- --- <br /> -­--------------- -------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have.prepared this application and that the wont 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 licew <br /> sed agents signature certifies the following: <br /> "I,certify that in the performance of the work for which this permit Is Issued, :1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of californla." <br /> Signed . <br /> ----- --------- ---- Owner ? <br /> BY °..__. ol •---------• .Title -----'-..---- <br /> (If f er r <br /> FOR DEPARTMENT USE ONLY <br /> APPLIC;AfiiON ACCEPTED 8Y 1 -TM -- - -- --..`.._. ..-- T DATE. r <br /> - --- - <br /> 3 <br /> BUILDING' PERMIT ISSUED ------ . . ,. ;DATE .. <br /> = ------ r. <br /> ADDITIONAL COMMENTS ----------------------------------- <br /> ----- `' ,b"' <br /> ---------------------- ........_ .. <br /> ------ ----------------•-•------ ............... ......_.._.... ............... <br /> .......................... <br /> ------------ --••----......""..... := ' �' s.. --------------------------------------- - ---------- - ---------------- 4 <br /> Final Inspection by, -:• Date _ — — �........._. <br /> EH 13 2h 1-•b8 I�rr. <br /> SAN JOAQUIN LOCAL",HEALTH DISTRICT, 8/74- M <br />