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FOR OFFICE USE: ? APPLICATION FOR ,-SANITATION PERMIT <br /> --- �� ' .�V Permit No. <br /> (Co tete in Triplicate) <br /> -- --•------------ - --------- ---------- --------------- r <br /> _ � <br /> --------------- --------------------------------_ This Permit Expires 1 Year From Date issued Date Issued <br /> � <br /> 0 � <br /> —0-7-1, ST -7-3_f 2.3 _t/ - <br /> Applicat?on3 isiereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application4s made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ._ 9_ E Tfzd' -------------&- - ------ - ---._'Y`- --- ...__CENSUS TRACT <br /> Owner's Name ----d------- --- -------- ------------------------------------------ - Phone <br /> Address ---- cc�"�, City -------------------------------------------------------------------•- ...... <br /> Contractor's Name Y License # - Phone <br /> Installation will serve: Residence M�X`partment House❑ Commercial ❑Trailer Court ;❑ _ <br /> Motel ❑ Other - ---- ------------------------------------- <br /> Number of living units ----- Number of bedrooms _..�-------Garbage Grinder ---n'K3_ Lot Size f S- -fa----- - <br /> Water Supply: Public System and name ----- ------------------------------------------------ •---------------Private ❑ f <br /> Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam .E W <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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [< SEPTIC TANK'[ j Size__ _ __ ________________________ Liquid Depth -`---------------------- <br /> Capacity <br /> ----._________----__Capacity -8"ga _-- Type -- ti -_ Material--- ----- - --- ---- No. Compartments ------------------ <br /> Distance to nearest: Well ---'---------------------------------Foundationm_t_--------------- Prop. Line _47-1------------______-_--__ <br /> LEACHING LINE [ No. of Lines __ ________________ Length of each line_--�_-______..____---- -- Total Length _� ..--.__________._ <br /> 'D' Box _ _.__ Type Filter Material __ S°_G _____Depth Filter Material _117_4_______._x! . - <br /> Foundation Ib per Line �___-------•-------_--- <br /> Distance to nearest: Well __-- --- ----------_---- <br /> Distance Property <br /> .______ Diameter <br /> SEEPAGE PIT [� Depth __�-.__._ -�-'_'_�__--______ Number ________ <br /> -----' .___ _______ Rock Filled Yes ® 0� No <br /> - it / <br /> Water Table Depth ----- ----------------•-- --------Rock Size L" �� <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------.__....._--.•-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> SepticTank (Specify Requirements) ----------------------------------------------------------------------------------•--------- --------------__------- --------------------- <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <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 /> i , <br /> BY --- <br /> Title ------------------------- --- <br /> (If other than owner) <br />' FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ _�_ej------ - Z)-V0 ----) - ---------------- --------- DATE ---- - = --------- <br /> BUILDING PERMIT ISSUED -------------------------------------------- -----------DATE ------- ----------------------------------- <br /> ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------------------------------------------=--------------------------- <br /> 1 ' <br /> ------- --- ----------- - - ------------- --- <br /> ---------------------------------------------------------- -----i------------------------ --------------- ----------------------,----------- <br /> ---------------------------------------------- --------------------- <br /> - - - --- ----- <br /> ---------- - ------- ------- ---- ---- - - <br /> Final Inspection by: --------------- ----P- U �l �. Date _ - i�------- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />