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' - FOR OFEIC USE: APPLICATION FOR SANITATION PERMIT <br /> ----- ---- ------ -------- --- Permit No. 7 ------ <br /> (Complete %.-�__ . <br /> (Complete in Triplicate) <br /> ---------= ------ -- - <br /> Date Issued- <br /> --------------------- This Permit Expires 1 Year From Date Issued <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 ._L�_��__�',����//�----------------------------------------------------------CENSUS TRACT <br /> Owner's Name 8114Z----- - ------------------------------------------------- ------------------------------------Phone�y� s._. '1 <br /> Address -------,7&--/------��.4- ------ ------------------------------ <br /> �A7 City G-� r " ------------------ <br /> Contractor's Name ��4`, -----St_ -k� -- <br /> ---------- ------------------------------------License # /7,74ff,6,----- Phone��� .. <br /> Installation will serve: Residence 0 Apartment House,❑ Commercial []Trailer Court F1 <br /> Motel ❑Other ----------------------------_ -----_----- <br /> Number <br /> ----_- --Number of Living units:__`_____ Number of bedrooms ---/------Garbage Grinder: __)VV Lot Size _c am 4- _____-____-__------ <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 ❑ Aclobefig Fill Material ___:________ If yes,type _________________ _ ________ <br /> `e. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) O� <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> CIO <br /> PACKAGE TREATMENT [ ] SEPTIC TANK,[ ] Size------------------------------------------------ Liquid Depth .......................... <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' Box ------------ Type Filter Material ____________________Depth Filter Material __________-___- --------- .............. <br /> Distance to nearest: Well ______________________ Foundation Property Line ._..____......... ...... <br /> SEEPAGE PIT [ ] Depth ____________________ Diameter ------ ......... Number _______ -------------------- Rock Filled Yes '❑ No 0 <br /> WaterTable Depth ------------------------------------------------Rock Size -------------------------------- . <br /> Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- --_----------------------,..--- ----------------_---- <br /> Disposal Field (Specify Requirements) -----940-- ___ye�G' __. //,l�1 ----_--1 a--- a -— __ _J� / -------- <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 cohlect to Workman's Compensation laws of California." <br /> Signed ------ ---- ----- ---------------------------------------------------------------- Owner <br /> ------------------------------------------------------------ Title - <br /> By ------ - --- ----- --------------------------------- --------------- <br /> If other than owner) <br /> PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- - ------------------------------------------------------------ DATE 9= -��----------- <br /> BUILDING PERMIT ISSUED--------- - -- ---- -- -- - -------DATE -------------- ------------------------_--- <br /> ADDITIONAL COMMENTS - ----------------------------------------------------------------=-----T- - - ------- <br /> ------------- <br /> ------ <br /> 7 - ----- d-------�2rr_'- cv E'r-------4'-po j, ------ <br /> �i2li <br /> ----- -- ---- ----- - ----- - ----------------------------- -------- --------------------------------------------------------- <br /> ------,r'-�l)-47 --- -- -- - ---- --- -------- -- - ------------------------------------------------------------------------ -------------- -------------------- --------------- <br /> Inspectionby: ---------- -- ----- --• ------ ---------------------------------------------------------Date --- -------------- <br /> N JO QUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Re <br />