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/ FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - ---------- Permit No. /-�S`9 <br /> (Complete in Triplicate) --•--�........ <br /> 1 This Permit Exp'ire's T Year From Date Issued 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 ...-:?-.�-----'Jit---G�� � � r- *".4�,le-a'CENSUS TRACT ------------.......... <br /> - <br /> Owner's Name ----------- -- ---•-•--------- --Phone ,I <br /> AddressQ� City <br /> ---- -- - ------r F-- --------------License #cr2E l- -- Phone �° 9 <br /> Contractor's Name __-___� <br /> Installation will serve: Residence*Apartment House❑ Commercial ❑Trailer Court !❑ <br /> Motel ❑Other ------------------------------------------- <br /> Number of living units:--- ----- Number of bedrooms .......Garbage Grinder______ Lot Size ��- <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 ❑ 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,) <br /> Ir`,,, � r <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Y� Size._ _--,r0----------- -- Liquid Depth ----- -------------- ...... <br /> Capacity loliW-6A' <br /> - -__-_- <br /> CapacitylooliW-6 LType/I&C,r¢•t'fMaterial_Lc' No. Compartments ....62- <br /> Distance to nearest: Well � ---4--c -------- _ `� <br /> __4� •� __ Foundation _. ___U_._.__._.__ Prop. Line ----- <br /> LEACHING LINE rV- No. of Lines ------------- Length' of each,line-___.l�S'r__-.____ Total Length ,_ �J........... <br /> D' Box .__ ____ Type Filter Material r�'�'�-----Depth Filter Material-. ----- ....................... <br /> Distance to nearest: Well t/v'---esJ¢ Foundation --------- - Property Line ...477� ............. <br /> SEEPAGE PIT Depth o -S _f_-__ ,Diameter s _.`_^ Number -----a2------------------- Rock Filled Yes,k No i❑ <br /> I- r � <br /> Water Table Depth -----------------------------------5$1 Rock Size - �-- _ <br /> Distance to nearest: Well .t,Ia---- .........Foundation -_1'�_---_-___ Prop. Line .....7.............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------------------------s-- Date _-___-__-_____-_____-----------___) <br /> Septic Tank (Specify Requirements) --------------------------------------- ---------•-----------------,._•--•---•--•-------------•-- <br /> Disposal Field (Specify Requirements) ------ -------------------------=--------------------- i--------------------------------------------------------------------- <br /> r <br /> --------------------------------------------- ------------------r--------------------------------------------------------------------------------------------------_._.------------------------ <br /> ---------------------;------------------------------------------------------------------------------------------------------------------------------------------------- <br /> .-------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------ <br /> (Draw existing and required addition on reverse side) i <br /> I hereby certify that 1 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 subject to Workman's Compensation laws of California." <br /> Signed - ----------------- ------------------------------------------------ -. ---- Owner <br /> BY ------- G J --- -- _ Title -------(,_- ---- -- .�.,N =---- ----- <br /> (if other than owners <br /> FOR DEPARTMENT USA ONLY <br /> APPLICATION ACCEPTED BY --------------------------- DATE <br /> DATE -------------------------------- <br /> BUILDING PERMIT ISSUED -------------------------------- <br /> - ------ --- - - -- <br /> ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------ --------------------------=--------------------------- <br /> -------------------------------------------------- <br /> --------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------r------------------- ------------- -------------------- --------------------------------------------------------------------- --•----- <br /> " ,r' -- - ------------- <br /> Final Inspection by: , <br /> - ;_ -- -- --- - �- ----- - - - - - Date = = � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT f t' <br /> E. H. 9 1-'68 Rev. 5M <br />