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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT 3a� <br /> --- --------------------------------------- Permit No: <br /> (Complete in.Triplicate) <br /> -------1- --------------- ---------------------- p <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 Count dinance No 549 and existing Rules and Regulations: <br /> �} pay �v . <br /> JOB ADDRESS/L%TION i - ---------------------------------- CENSUS TRACTOwner's Name -- --- -- --------------- - ---------- P ----------------------------•-- <br /> G ----- ------- - -== --------------- Ci ----- -----f------------ ----- <br /> ----------------- <br /> Address --- <br /> Contractor's Name ------------------------------------------------------------------------------=---------License # ------------------------ Phone ---------------------.. _--- <br /> Installation will serve: Residence e_<Partment House[] Commercial []Trailer Court- ❑ - <br /> t, <br /> Motel ❑ Other ------------------------------------------- <br /> Number <br /> --------------------------- -------------Number of living units:----._;----- Number of bedrooms _____Garbage Grinder ------------ Lot Size ----------------------- -------------------- <br /> ---------------Supply: Public System and name'-- -------------------------- - " =---------------"Pr <br /> Zf -- <br /> Character of soil to a depth of 3 feet: Sand ❑ .Silt❑ Clay Peat❑ Sandy Loam •❑ Clay Loam <br /> Hardpan E] Adobe's-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,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK'I l Size-------.----------------------------------------- Liquid Depth -----------------_------- <br /> -- Mat'ter'ia1._ .�__ _.'No Com artments ------_------•-• <br /> Capacity ---------------------- Type p <br /> Distance•tomnearest: Well .----------------- -----------------Foundation ---------------------- Prop. Line ---------------........ <br /> LEACHING LINE I l No. of Lines --------------------- -- Length of each line---------------------------- Total Length ,-----------.--------------- <br /> 'D' Box ------------ Type f=ilter Material ------\-----------Depth Filter Material --------------------------__________________ <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line. ------------------_---- <br /> SEEPAGE PIT [ j Depth - Diameter ________________ Number ---------------------------- Rack Filled Yes ❑ No i❑ <br /> WaterTable Depth ---------------------------------------------`---.Rock Size -----=-------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation ---------------.---- Prop. Line -------- ------------- <br /> ` -- ,� -------- Date --------------- ------- <br /> REPAIR/ADDITION(Prev. Sanitation Permjt } <br /> Septic Tank`(Specify Requirements) - -- - -------- - -- ---------- ---' --- - <br /> Disposal Field (Specify Requirements)� '-��---�-�-�"'- -------- /------�u �'�--�-8-�-----------�------ <br /> ------r---------- -- --/ - <br /> r -------_____ _�'' -.____ _______________________________ _ _______ ________________________________________________�_____--________-________. <br /> f <br /> -------------------------------------------=-------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I <br /> k I hereby certify that I have prepared this application and thatithe work will be,done in accordance with San Joaquin <br /> i County Ordinances, State Laws, and Rules_and Regulations of 41 e­San Joaquin Loc*4 Health District. Home owner or licen- <br /> sed agents signature certifies the followln * ' <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 bec�orn ubject to Workman'stCompensation laws of California." <br /> Signedl'_.]. Owner <br /> ------------------- Title --------- -------- - -------------------- <br /> -------------------------- <br /> s (If other than owner) <br /> i FOR, DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------------------------------------------------------- DATE --------- <br /> BUILDING .PERMIT ISSUED -------------------- ----- - ------------------ - - ---------------------------DATE ------------------------------------------- <br /> - ------------------ <br /> ADDITIONALCOMMENTS ----------- ------------------------------------------------------------------------------- ------------------------------------------------------ --------I <br /> ----------- ---------------------------------- <br /> ---- <br /> -------- <br /> --------------------------------------------------------�------------------------------------------------------------- <br /> ------------------------------------- ----------�-- --- <br /> `7 <br /> Final Inspection by; - 'r ' +' ----------•------------- -------------------- Dat - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br />