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FOR OFFICE USE- <br /> ........ ..................:................... APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) <br /> 7. <br /> . Permit No. -- .- 3. . <br /> .....----•--•......... <br /> This Permit Expires 1 Year From Date Issued Date Issued y..? <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 /> t(.V--;... --._,,,-,,,,,---.� I ,Lt T <br /> JOB ADDRfSS/LOCATIO *70z �. ..CENSUS TRA'CT­7'-!,:;��.." <br /> Owner's Name ............. .... tl-. a�.�►'. ...:...........•............... ................. ... ......Phone .... � . <br /> 6 <br /> Address ................. city .._ . ...Q ..�... <br /> : - t.._ �=- .. .. . ............ . ........................... . . <br /> Contractor's Name <br /> _ -----..". ......................License :. `"-3.. Phone _ <br /> Installation will serve: Residence Apartment House 0 Commercial QTraller Court Q <br /> Motel Q Other ;.:.. _..:......_ :.::.. <br /> Number of living units:...... Number of bedrooms ... ......Garba.a ge Grinder <br /> Lot Sirs .................. <br /> •,. ,P is w�-7:�, G✓t I <br /> Water Supply: <br /> Pub' System grid nc�ine ---=------ - --------- ��� <br /> ►� ........_.. - •- -i== . .. .......................Private 0 <br /> Character of soil to.a depth of 3•feet: --Sand.Q. Slit Q Gay C'J Peat Q Sandy Loom Q Clay Loam.Q . <br /> Hardpan Q Adobe'• Fill Mpterlal . .........if yes,type ..........:.:.. ............ <br /> (Plot plan, showing size of 'lot, location of system in rotation Jo,,wells, buildlrigs, etc:mvit 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. I � T .....�'�... .....�� . � Liquid Depth <br /> r - . .......... <br /> CapacitySEP IC TANK <br /> .... S <br /> y Mat_erlal. .................�. No. Compartments . <br /> Distance to nearest: Well ............. ....................t6undation ._...._... .. Prop. Line .. <br /> LEACHING LINE [ 1 N <br /> o. of Lines ........................ Lente f ;eaeh line.._... :".............. Total Length .. -� <br /> ..... ...-- <br /> �` 'fV Box Type F#Iter•Material ► .. Depth .Filter Material <br /> Distance to nearest: Well .....................�._ Foundation ................. Property Eine ........................ <br /> SEEPAGE PIT [ } Depth .................... Diameter ..............-- Number .........................1 Rock Filled Yes Q No.QV <br /> Water Table Depth ........1_Roek Size . <br /> Distance to nearest: Well ....................... •..-....-z_.foundation .......... ......... Prop. line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _t..................:............. Date <br /> .......................... <br /> Septic Tank (Specify Requirements)... ._�..�_._... 1 3 <br /> -- --------------- <br /> Disposal Field (Specify Requirements) ........QA -......... <br /> . _--! ¢.E. --•••-- - ~ <br /> r -I- <br /> . <br /> {Draw existing and required addition on reverse side) . <br /> I hereby certify that If have prepared this application and that the work will be cone In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the 'San Joaquin Local Health:District. Nome owner or li=en- i <br /> sed agents signature certifies the following: ` <br /> "I certify that in the performance of the work forwhich this permit is issued, I shall not.ernpfay any person in such manner <br /> as to become F <br /> subject to Workman's Compensation ensation laws of California..,., <br /> Signed ------ <br /> - <br /> -- . <br /> BY ---- - -- <br /> ------.- .Owners <br /> ------------------- Title <br /> -- '. <br /> ( of r han owner) '�l <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACC PIED BY ----- <br /> - DATE ....... . ...z_Z .. ---e .... <br /> ADDITIONAL COM ... ........... <br /> BUILDING PERMIT ISSUED .. <br /> --------------•--......----••---......... ------......._.._...-._._........._DATE ........:......----- -- <br /> TS.._._..._ ... . ........ . ................. --------------------• -------------- <br /> _ <br /> -----••------• ---- <br /> . ---- - --- - - - --•------ ._..... ---•..----... . <br /> Date ....... � <br /> . ..---- <br /> / :...:...........--Final Inspection ___ <br /> EH 13 2h 1-•68 Rev". 5 SAN JOAQUIN LO L HEALTH DISTRICT 8/7h 3M <br />