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o APPLICATION FOR SANITATION -PERMIT 7 //_ <br />-----------I--- <br /> - - - - -.--- -FOR OFFICE USE: �-- ------- Permit No. -._71._.__-_._..-. <br /> ---------- - (Complete in Triplicate) a2 yl p 7� <br />---------=------------ i�- 7S/ <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 County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOcCAATTION ...� ¢3---- `-- ---- r------- �3 -- ------CENSUS TRACT -------------------------- <br /> Owner's Name 1J l----- ah-m�/----------------------------------------------------------------- -----.-Phone <br /> Address _-Z-2-38......5-:------lr/----------------------------------- • . City -------- <br /> Contractor's <br /> ------Contractor's Name -----------License # - �SZ� Phone <br /> Installation will serve: Residence)kl"Apartment House❑ Commercial [-]Trailer Court ;❑ <br /> Motel ❑Other -------------------------------------------- _ X, /0 Q <br /> Number of living units:---I------ Number of be ooms ----Z---.Garbage Grinder ...--------- Lot Size _- --. ------------- <br /> Water Supply: Public System and name ----------- `-- --------•-- --- -- <br /> ----------------------------------------------------- -------- --------------------------Private E]=------ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ <br /> Peat Sandy ❑Loam Clay Loam El <br /> Hardpan ❑ Adobe ill 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[ ] Size------------------------------------------------ Liquid Depth -------------------------- <br /> Capacity -------------------- Type -------------------- Material.--------------------- No. Compartments ................... <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----___-f.........._ <br /> LEACHING LINE [ ] No. of Lines -----/--------------- Length of each line----'p7_S7f------------ Total Length ___U-- -_---•-__-__.- <br /> - ri <br /> ,�e� 'D' Box 46-^J--- Type Filter Material _/.2x--_._.Depth Filter Material ...��________________�.-_........ �( <br /> F, - <br /> Distance to nearest: Well __A/elle- _-_ Foundation _./_ ----------------- Property Line -S_-_-................ <br /> et -� <br /> SEEPAGE PIT [ ] Depth __cry- ----- Diameter -..3.3_-_-_._ Number ___-_ _- Rock Filled Yes '�o d <br /> Water Table Depth ---.---4- -------------- --------------Rock Size v2_ <br /> Distance to nearest: Well _-_-1*,V''>+- -_____________.....Foundation _/Q---.-----_-__ Prop. Line .::5.............. <br /> 17 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) ----------------------------- ---------------------------------- - ----------------- <br /> DisPosal Field (Specify Requirements) -__c:� _ -5-----, --� <br /> _- <br /> ------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I 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, I shall not employ any person in such manner <br /> as to become ect to Wor man' Comp �sation laws-off California." <br /> Signed ------ -- ! Owner <br /> BY ------- -- --- ---- - ---- . --- ----By <br /> (If other than o r) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- ------------- ---- -------------- -------------- DATE T- -.7 <br /> BUILDINGPERMIT ISSUED ----- - -- ---- ----------------------------- ------- -----------------------------------------------DATE ------------------------------------------. <br /> ADDITIONALCOMMENTS ---- ----------------------------------------- ------------------------------------------------------------------------------------------------------ <br /> ---------- ------------------------------------------------------ ---------------------------------------------------------•---------------------------------------------------------------------------- <br /> ----------------------------------------------------------- -------------------------- ----------------------------------------------------------------------- -------- <br /> --- ---- `�J � - ------------- <br /> ----------------------------------------- -------- - - ------- ------------------------- ------------------------------------------------- / f <br /> FinalInspection by: ------------ -- ------------------------------ -----------------------------------------------Date -------- - ------------ <br /> SAN JOAQUIN LO AL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />