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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------------------------- Permit No. 6 <br /> \1 (Complete in Triplicate) <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> 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 <br /> -^' -- --- ------ ----------��,� � Pe�.------- - CENSUS TRACT -------------------------- <br /> Owner's Name -------!"1'-f----- le ----------------- ---------------------------------------------------------Phone ------ <br /> Address --------------� �`�f^ --------------------------------------------- --. City --- ^------�e"AR ------------- <br /> Contractor's Name ___ __._ _ k _ _______________________._-____.License # �a_ _ Gam-Phone <br /> -_-__ -_-_ r <br /> Installation will serve: Residence ❑Apartment House,❑ Commercial []Trailer Court in <br /> Motel d Other ---+ ----------------------------- <br /> Number of living units:____/---- Number of bedrooms'"0-2---_-_Garbage Grinder Lot Sized _,e7- " -'--------------- <br /> Water Supply: Public System and name ---------------------------------•--"--------------------------------------------------------------------------Private 5( <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam' Clay Loam ❑ <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,) Q► <br /> PACKAGE TREATMENT SEPTIC TANK' Size_._ __ \ <br /> [ ] J� , a ---------._ Liquid Depth <br /> Capacityh,e_i�_- Type Material_ ' .- __ No. Compartments ... . ............ <br /> Distance to nearest: WellC`--_--_______________Foundation,/ ------ Prop. Line ._uv-- ----- <br /> LEACHING <br /> -LEACHING LINE No. of Lines ---9----------------- Length of each line__,?Z9 ____._ Total Length ,` -___-__-- <br /> 'D' Box 1/4e_!�; Type Filter Waterial1 j_/?0_l�Depth Filter Material x�----------------------------------- <br /> Distance to nearest: Well --- Foundation �_______ Property Line --- Gg_.......... <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No,0. <br /> Water Table Depth -------- -------Rock Size ------- --------- -------------- <br /> Distance to nearest: Wells________________________________________Foundation __.----------------- Prop. Line _-------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ____-_-_-____-.__-..-__-_______:_.) <br /> Septic Tank (Specify Requirements) -------------------------------- ----------------------------------------------------------------------------------- ------------------------ <br /> Disposal Field (Specify Requirements). __________-_______- ..-_. -_ ----------- -_._._ . .. -._ ---------------------------- <br /> ------------- <br /> ----------- <br /> - <br /> _________ _ _____ ________ <br /> - - ---- ------ <br /> ---------q_�ae­_- ----r? - - <br /> ------------------------------------------------------------------------- <br /> . <br /> (Draw existing a required"ailpfl'opH 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 Ruleir 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 Comp sation laws of California." <br /> Signed ------------------- - ----------/----------- ---------------------------------- Owner e -6 ----- Title -------l <br /> (If than owner) <br /> FORD MENT USE ONLY <br /> APRj_ICATION ACCEPTED B - - --- ----------------- ------------------------------ DATE -71� Q--- ------------------- <br /> B JILDING PERMIT ISSUED ---------------------------------J------------------------------------ -------------------------------DATE ----------------------------------------- <br /> ADITIONAL COMMENTS ----------------------------------------------------------------------------------------------- --°---------------------------------------------------- <br /> ----- -------------- --------------------------------------------------------------------------------------------------------------------- <br /> -------------------------- ;-- <br /> Final Inspection by: <br /> --------- ---=-=�----------------------------------- - ---- --- ---- ---, - --.-Date :._« <br /> -------------------------------------- - -------------- -- ---- --------- <br /> 4`SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />