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Olt C►�. ?id USE: �-•- ., <br /> • -'t' �'' APPLICATION FOR SANITATION PERMIT <br /> w____________________________ _4 ` T - F: i . <br /> r �/ <br /> _ (Complete in Triplicate) Permit No: . ......./-. . <br /> ---- -... .. ••-•------ <br /> --------------------- .-._.. -----------..._.----. This Permit Expires 1 Year From Date Issued bate Issued ..�� ��3�� <br /> .;7—&T to 2-0 —12— <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., l�C�1t]#made in compliance witQ�d' 9 and existing Rules and Regulations: <br /> JOB ADbR1=S5/LOCATION C- - -- s ! <br /> 1�a _ ..... .. @NS!®J ACT _.. .._.. �� <br /> i'�,! ` <br /> Owner's Nam _.._-- a �J��---------------------------------->.-•-•-.............Phone_ <br /> Address <br /> Contractor's Name __�_tv_e__.___ �- ...........License # � .r f _ . Phone 21.�:1d4 . <br /> Installation will serve: Residence❑Apartment House C] Commer�cryiioll N]Trailee Court <br /> Motel 0.0 er.7/PV C_ ... /___d� <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'❑ Silt❑ Clay ❑ Peat.❑ Sandy Loam Clay Loam ❑ <br /> Hardpan ❑ Adobe.0 fill Material ..l '... If yes,type............................ <br /> (Plot fan, showing size of lot, location of system in relation to wells, – ...-.� _ <br /> P g y buildings, etc. must be placed on reverse side.) l�r <br /> NEW INSTALLATION: (No septic tank or seepage it permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK T ] Size___________________________•_--._...--__.___j- <br /> Capacity <br /> liquid Depth --__--__---__-_._-.---------------- --- Type ------------------- Material....-----------------• N Compartments ............ <br /> i <br /> Distarice to nearest: Well - - _--__------•-_--.Foundation --------__ ......prop. Line ..............___------ <br /> LEACHING <br /> ___iLEACHING LINE [ ] No. of Lines ----------------------- Length of each line---------------------._--__ otal Length ----------- .......... <br /> 'D' Box ------------ Type Filfi aterial --------------------Depth Filter Ma ia) -------------_.___...------ •----••---:._. k <br /> Distance to nearest: Well _ _____ _______________ Foundation ----------------- __ Properly Line ------------ ......... Z r <br /> SEEPAGE PIT Depth __/4t__.04�Diameter WO_�Number ----------f-------- __. Rock Filled Yes Is No id.., <br /> Water Table Depth ------------------------------------------------Rock Size ---✓ ------------- ` u <br /> Distance to nearest: Well ________________________________________Foundation _` Z__f______- Prop. Line __14_______.____. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------ Date <br /> Septic Tank (Specify Requirements) ____________________ -- �! <br /> Disposal Field (Specify Requirements) --------------- --------•------------------------------------------------------------------------------------------------------------ + f <br /> I I <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- <br /> ".------"'---------------"--- ------ <br /> -- <br /> (Draw existing and required addition on reverse 'sidle) <br /> 1 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. Horne owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that i he perfor of the k for which this permit is issued, I shall not employ any person in such manner <br /> as to becom lect t nsation la*-4 of California." <br /> i <br /> Signed -�° ----------------- Owner <br /> By ---------------------------------------------------------- - -------------------- - ------- Title ---------------- <br /> ------------------------------------------------------- <br /> (If other than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY 1 1 _-Z'? <br /> - DATE -------2----,5---71 ------ <br /> BUILDINGPERMIT ISSUED --------------- ------------------------------------------------------------------------------- --------DATE ------------- -------------------_ ------- ' <br /> ADDITIONAL COMMENTS --- --- -- ------------ ------ - - - <br /> ---• - - ------------------ - --------------- <br /> ----------- ------------ <br /> - -------------------- ----- - --------- - - - <br /> ----- --- ------- - --- - - -- ------------------------------------------------- -- <br /> Final Inspecti by: ---- ---- ------ - -- ---- ----r------ --- ----- Date -------- ---- <br /> SAN JOAQUIN LOCA. .,HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />