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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 'Complete in Triplicate) Permit No. __7-------------_ <br /> . <br /> -------- --------------- --- , <br /> ------------- <br /> Date Issued ___--------------- <br /> Application <br /> -ISr-7 <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 CountyOrdinance <br /> ^No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOC TION .__.'�7�7�—.__S____-_�----T(_N--------F�_1.------------------------CENSUS TRACT ___-S �--. <br /> Owner's Name _. <br /> - -- --------------Phone --�--��--.�--�---- <br /> Address ----9 7t----------- ----------- -------------------------------------------------- Cit 1c_( U <br /> Contractor's Name ---(R-A _------ l ------------------- _ __.License # '� <br /> Phone,1 <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ <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❑ Gay E] Peat E] Sandy Loam Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type .__-____-______-____-_____ <br /> (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitte if public se r is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK,[ ] • e------------------- ---------------------------- Liquid Depth -__-___-_---__-_--._____- <br /> CapacitY -------------------- Type -------- ----------- Mater' ---------------------- No. Compartments ------------------•--- <br /> Distance to nearest: Well _____ ______________________ ______Foundation ---------------------- Prop. Line ...................... --� <br /> LEACHING LINE [ ] No. of Lines ------------------------ ength of a line---------------------------- Total Length -----------_________________ <br /> 'D' Box .----------- Type Filte Material ___ _______________Depth Filter Material __-.____________-__._----------_-•_---_... N <br /> Distance to nearest: Wel __________________ ____ Foundation ------------------ ----- Property Line ________-.-_-___--..---- <br /> SEEPAGE PIT [ ] Depth ___________________ ameter ----- ---------- Number __________________________ Rock Filled Yes '❑ No C] <br /> Water Table Depth ------------------ --------------------------Rock Size -------------------------------- <br /> Distance to neares . Well --------1___________________________...Foundation -------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permi # -------------------------------------------- Date __-___--_____________________---_.) <br /> Septic Tank (Specify Requirements) -------4-4---- ------------------------_-------------_---------- <br /> -_-------------_-------•--- 3. <br /> Disposal Fiel (Specify Requirements) ------ _ ' -6 - - -,-+ -f�� ----- <br /> -----------------------:1�----- Z-------- '�-j � '� -- -------- ----------------------------------------------------------------- <br /> ------------------- ---------------------------------------------------- ------------------------------------------------------------------------------------------------------ ------- <br /> (Draw existing and required addition on reverse side) <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 subje to Wo `an's Compensation laws of California." <br /> Signed ------ ---- ----------- - -------------------------- ------ -------------------. Owner <br /> BYd `' - -- ------------ �•----------------------- Title ------------------------------------------------------------------------ <br /> (If other than owner) <br /> �--p FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----I--t-f1--A------------------------------------------------------------------------------ DATE .' <br /> BUILDINGPERMIT ISSUED --------------------------------------------------------------------------------------------------------DATE ------------ ---------- --------------- <br /> ADDITIONALCOMMENTS ------------------------------------------------------- --------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------- ---------------------------------------- ----------------------------------------------------------------------------------------------------------------------- ...... <br /> --------------------------------------------- <br /> FinalInspection b / -------------------------------------------------------------------------- <br /> --- ---------------- <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ; <br /> E. H. 9 1-'68 Rev. 5M °—��� <br />