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OR FFICE USE: ® <br /> ,?p fl Fl APPLICATION FOR SANITATION PERMIT <br /> . .. .....................P....•..... <br /> ._. . <br /> (Complete in Triplicate) Permit No.7 - .... <br /> .................. This Permit Expires 1 Year From Date Issued Date Issued <br /> WO` J'I - 074Uo a— A/ 4rRA <br /> Application is hereby mad to the San Joaquin Local hlealth .r District for a permit to construct and install the work herein <br /> de rib . T is licoti Made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> D JL CATI N 1 �1�l � l1. <br /> �.'(-.�.�f .L�'� �cf..I..ik..CENSUS TRACT ..................cc.// .. <br /> Owner's Name ....... � D ... Phone ,T�'.".f i . ,T.-.,. <br /> Address ......................... . . .. .... ....... . , . .. . ................ City .......... ....... .. <br /> Contractor's Name .......License #,fY:7_Lt3.. Phone i...v. ...IP.Q, <br /> S°y` <br /> Installation will serve: Residence M Apartment House❑ Commercial❑Trailer Court 0 <br /> Mote ❑Other ............................................ <br /> . ... ...5 <br /> Number of living units:. ...... Number of bedrooms ... ......Garbo a Grinder ............ Lot Size .„ll..S�..X.,�l.z.............. <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 0 <br /> Hardpan❑ Adobe' Fill Material ............ If yes,type............................ <br /> (Plot plan, showing size of lot, location ofsystem 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 [ , SEPTIC K ze.. 14..c? ......................... Liquid Depth .... , ............. <br /> Capacity . . . . . ...... Type ollai..... Material...fr :. No.%.Compartments ...:.: ��..::........ <br /> Distance to nearest. Well Sri 't” Foundation . r <br /> ./..5� : :.;�, . Prop. Lina .�.. ....... <br /> op <br /> LEACHING LINE [ No. ,of (root �!.....�...._Length of.edch e.... __� .•_-..__ 'C li. math ..alp............ <br /> Type Filter Material ...Depth Filter Material �,. - •, +. ............................, <br /> Distance to nearest: Well ...,.t�Q '1- ...... Foundation ....A 7`..... Prope .............: :. .... <br /> SEEPAGE PIT [x Depth ...., , '....•.. -Diameter - ��. 'Ndniber . ..`jam... ..: . Reds` Fill ,e No 0 <br /> 1` r. .�� <br /> Water Table Depth ....................Rock Size .. . .,�. <br /> Distance to nearest: Well..../00.........................Foundaticw-:_-.20tg f'..... Prop. tins _ ....... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................) <br /> SepticTank (Specify Requirements) ---•-•.............................................................................................,.. _ ;......_...._.._ ............ <br /> DisposalField (Specify Requirements) ..----.....-•...............•...........---.............---..... ..__..----.................. ................................ <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 Joa4v -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 an* person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> a <br /> Signed ... . •--••-. .• ................ OWn—,6 <br /> ( ..•---•BY -- --- -- . ..... Title ... .................................................... <br /> - <br /> an owner) <br /> F R DE ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE .�I�....tV._�L.� <br /> BUILDING PERMIT ISSUED ................. <br /> _....... ::::: ................._ '..... _............DATE _ ......................... <br /> ADDITIONAL COMMENTS <br /> ..........................•------......................................................................................................................................................----............... <br /> ........................................................................•................................................................................................................................. <br /> Final Inspection by: .....� ... ...........Date �l'7Y. .. ..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 24 I ' Rev. 5M 7/72 3�'C <br />