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FOR OFFICE USE: <br /> . 7APPLICATION FOR SANITATION PERMIT <br />.............._.... ............ ........... ........ Permit No. ••• <br /> .._�j <br /> (Complete in Triplicate) ----�•----•• • <br /> 4­1;x�Ai ..... ............. - <br /> . Date Issued .1�..�...�.::.�� <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 /> �t p f cA.fPVD <br /> JOB ADDRESS/LOCATION ,..... w�.---._/�. .?7% ._.fc�. .._.. d.. . �' .........CENSUS TRACT .......................... <br /> Owner's Name ........ . D, N�L --....., G:.. ...............I.....................................Phone .................................... <br /> Address ......... . -- l9 fi1./YlG'�l�..._: .T.-........ -._..... ... City ---,� � ........................................... <br /> Contractor's Name .........A.a.Zi..... , ....................... .....License # Phone. r�.�... <br /> Installation will serve: Residence Apartment House❑ Commercial ❑T'railer Court 0 <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 d Pegt.❑ Sandy Loam 4 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 /> PACKAGE TREATMENT [ ] SEPTIC TANK f ) Size.... ".X..��j�X_ Z..... Liquid Depth ....... ...... <br /> Capacity e ...................... No. Compartments ...9 .•...,......... <br /> Distance to nearest Well ..........'{D..02.............Foundation ....... Prop. Line, <br /> LEACHING LINE [ ] No. of Lines -4� g ,,� . <br /> -------------- Length f ach line.. .Q---•-- -._----- Total Length _._�L!:' � . <br /> -X Depth Filter Material ..... v' <br /> 'D' Box ._.:1..._:- Type Filter Material".� �,� p _--•---- -.. ._... ..- ........ <br /> Distance to nearest: Well .. �............. Foundation l b.__............. Property Line . f................ <br /> SEEPAGE PIT [ ) Depth .................M:: Diameter ................_Number .......................Rock. Filled Yes ❑ No � <br /> Water Table Depth ,.;=.................Rock Size <br /> Distance to nearest: Well ...........................:.............Foundation Prop. line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# :-..............`..............I............ Date .................................. <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) .........................................•••-••-•---..••--•-•--••--•••.......-------•-•-•.........••••_. ... ..•-•.......... <br /> ........................................ . --------- ................._...........................................................................-................ <br /> (Draw existing and required addition onreverse side) <br /> 1 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, 1 shall not employ any person in such manner <br /> as to become subject to orn's C tion laws of California." <br /> Signed .......... C. r_._.. .... ........................ <br /> Owner <br /> B . ----------. .:...:.--•............:.:...... ...•-------•- Title ....._:...................................................._ ....:.......> <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ,' � ....................................................... . DATE . f.... <br /> BUILDING PERMIT ISSUED ::........DATE ......... .................. .......... <br /> ADDITIONAL COMMENTS .................................................................._............ .... ..._.: <br /> .....................................•-•-...........-•---.._....._.......-•-----•----•--......----••---....-•----......--.........-•---..._......-----•-••-------......................................... <br /> -----------------•---...---......--••----..........--.........---.............----•-•---.....----.......................----.......---.........................._...................................-•_... <br /> ---------------•----...•••-•......_............. .................._..---.............................................._._..... .......... <br /> Final Inspection by: .. .........................................................................Date . ......... ...._.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 241-'68 Rev. 5M 7/723 ,14 <br />