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FOR OFFICE USE: <br /> APPLICATION FOR .SANITATION PERMIT <br /> -------------------------- II------ -------------- �7 � <br /> Permit No. ---- -- --. <br /> = <br /> -----.--- -- -_-_---_ �I This Pe p-.-'I��--------------------- Permit Expires 11(Complete in Triplicate) 7(G <br /> Year From Date Issued <br /> Date Issued -��-��_- <br /> Application is` <br /> J:':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. 5.49 and existin Rules and Regulations: <br /> JOB ADDRESS/LOCA/TION --- -- Y� �_l ----------........ ENSUS TRACT -------------- ------ <br /> Owner's Name --- hl��l` � �= - _ Phone 9 _-------- <br /> Address -/-'.II <br /> 11­5�elvii;' -------------------=---------------------------------------------­­ City ' ---------- ----------------------- ----------- <br /> ' <br /> Contractor'sij 'ame ---- -'C ----------------------------------License # o?,;Z JY,�9- Phone.XdK� <br /> Installation will serve: Residence ❑Apartment House Commercial:❑Trailer Court ;❑ <br /> IMotel ❑Other -------------------------------------------- <br /> Number of living units:------- Number of bedrooms -j?--_--Garbage Grinder ./W__ Lot Size -_40V!°s 74! --__-------------- <br /> Water Supply: Public System and name ----------------------•---------------------------------------------------------------------------------- Private, <br /> q <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam'X Clay Loam El <br /> �! Hardpan ❑ Adobe❑ Fill Material ------------ If yes, type ------------- -------------- <br /> jPlot 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 [ 3 SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth ------------------------_ k <br /> Capacity ------ -------------- Type -------------------- Material--------------------.- No. Compartments ----------•-------_-- <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop..'-Line --------------- ...... <br /> LEACHING LINE [ ] No, of Lines ------------------------ Length of each line--------------------- Total Length^ ---------------------_---- <br /> 'D' <br /> _-_-- _-.-----_-_-_ ----'D' Box ------------ Type Filter Material __-_---------------Depth Filter Material --------------------------------------------- <br /> 1 <br /> Distance to nearest: Well ------------------------ Foundation -----------_------_---- Property Lire. ---------.-.-----_--_-.-_ <br /> SEEPAGE PIT ' [ ] Depth -------------------- Diameter _-----__------__ Number -------------- ----- Rock Filled -Yes ❑ No .O rn <br /> r� <br /> Water Table Depth ------------------------------------------------Rock Size ---------/---------------------- , <br /> Distance to nearest: Well ----------------------------------------Foundation ---------------------_ Prop. L-ine----------------_------ <br /> REPAIR/ADDITION{Prey. Sanitation Permit# ------------------ ------------------------- Date ----------------------------------- <br /> Septic <br /> --_-----------_ .---__--_--_-_---Septic Tank (Specify Requirements) -------- ---------------------------------- ----------------------------- -------------------•--------• --------------------•------- <br /> Disposal Field (Specify. Requirements) <br /> I 7A? <br /> A?---"------------- ---------------------------------------------------------- - ------- ---------- ------------------------------------ <br /> -------------- -------IN:---- <br /> II. (Draw existing and required addition on reverse side) <br /> I hereby cert fy 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 becomellsubject to Workman's Compensation laws of California." <br /> Signed -------- - / <br /> 'I-`' ------- --- - ----- --- ---------------------------- -- ------ Owner <br /> BY -I�' Title - <br /> ( er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONa ��! <br /> ACCEPTED BY ------------------------------------ -��"-�-------------•- ---------------...---- ----------- DATE ---- -------------------- ---------- <br /> BUILDING PERMIT ISSUED DATE - :.. <br /> ------------------------------------------------------------------------- - <br /> ADDITIONAL'I COMMENTS------------------------------------------------------------------------------------------------------------------- - - --•----------------• -------------- <br /> - <br /> Ih <br /> 'll' ---=------- <br /> ---- -------- -- - ------------------------------ <br /> ----- -- ---- <br /> ------------------------------- -------- -- --------- --- <br /> Final Inspection by: ------------------------------- - -= Date ,� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ". <br /> F_ H. 9 1-'68 Rev- 5M <br /> titer <br />