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FOR OFFICE USE: APPLICA ON -fOR SANITATION PERMIT <br /> . <br /> .............. <br /> Permit No. ...7. � .. <br /> (ConQplete in Triplicate) ' -- <br /> This Permit Expires 1 Year From Date Issued Date Issued <br />.................... .1. .......-.-....... <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 com,,pflance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ` S '-1 IV <br /> JOB ADDRESS/LOCATION ......2�.�.!?.�` _._�:�..... ......................CENSUS TRACT ...5..'.5... ...... <br /> Owner's Name ....... .0. E RT......M.t1.�.. ...................... ....... ....................Phone .................................... <br /> Address � .3.1-- city <br /> ........... ... -........----.................................................... ........ <br /> - - . <br /> Contractor's Name ..Q1!✓if E -.* ._:..- .....license # ........................ Phone .............................. <br /> Installation will serve: Residenceaffrrient iouie 0 Comrnercial Trailer Court 0 <br /> Motel ❑Other <br /> Number of living units:.... .... Number of bedrgQtns , ....Garbage GrindeLot Size ..ACREW-CC........... <br /> Water Supply: Public System and nomei -'. -4 Private ❑: <br /> ................ ....... ......... ......._..........................Pri <br /> t <br /> 6--rocter of soil to ddept',of 3 feet: Sand 0 Silt❑ Clay []. Peat❑ Sandy Loam Q Clay Loam 0 Q,1 <br /> ~ ` • Hardpan❑ Adobe 0 Fill Material ............ If yes,type............................ V <br /> (Plot plan, showing size of lot, location of system In relation to welds', buildings, etc. must be placed. on reverse side.) <br /> NEW INSTALLATIOW ` "(No septic tank or seepage t permittgd if public sewer is avails a within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size.::. ..................................... .... Liquid Depth .......................... <br /> Capacity .................... Type ...................lMaterial...................... I lo. Compartments ...................... <br /> Distance to neareio, Well .............. ...: ..........Foundation ..... . ... Prop. line ...................... <br /> .. ... . ........ <br /> LEACHING LINE [ ) No. of Lines -.. ....... 4 Length of each line......................... : Total Length,............................ <br /> D' Box ..........,. Type.Filte ,Materia) ...Depth Filter M terial <br /> Distance to nearest: Nell .................... Foundation .-......__..._.... ...... Property Line ....................... <br /> SEEPAGE PIT [ j Depth ...:..........�,:. , Pam �r ................ Number ..-................... ..... Rods Filled Yes Q No 0 <br /> x <br /> Water Table Depth ...... ...................................Rock Size ...... .................. <br /> Distance to nearest: Wel ...................................Foundation . ............ Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Pern*4 :....... .. ............................... Date ............... ...............) <br /> SepticTank (Specify.Requirements) ................... .......y............... t.:.............................................................,........................... <br /> i. <br /> Disposal Field (Specify Requirements) ........4041,?...."... P7 .... «+�.T..El4?.....- .......... <br /> ...... <br /> .....1 ---•----._�................ko_...... ._. f..1--..�� -------- <br /> 4 <br /> __--C- art....- � s..................=:.......... ................... _............................................................................................ <br /> (Draw existing am' required addition on reverse side) <br /> 1 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. Homo owner or licom <br /> sed agents signature certifies the following: <br /> "I certify t n he erfor nce of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to be [ to W n's Compensation laws of California." <br /> Signed .-... - ....... ..,,.��..n .... . Owner <br /> By ................... .- --.......... .. ......---.. ............`:.. .(.. .�. Title .........-.....................-....-................................... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY........F s. .!. ............................... DATE ....-. _.. , '7 .....r.......... <br /> .................................... <br /> BUILDINGPERMIT ISSUED .................................................................... '{.................::..............DATE <br /> ADDITIONAL COMMENTS ...._.. j .............._..........i-.,................................._... ............................. <br /> .................................... . ... ................... ...... . . ........................_..........................-......................................T.................. <br /> I< <br /> Final 1nsp.................. . -.. .........................................Dote . .�./.. <br /> .. .. ... . .:. . .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.H.13 241-'68 Rev. 5M 7/72 3 M <br />