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FOR OFFICE 'USE <br /> APPLICATION FOR SANITATION PERMIT <br /> Komplete In Triplicate}_.m_ <br /> Permit No �: ..../ <br /> .. :..... .. This Permit Expires 1 Year From Date Issued Date Issued <br /> ........ ......... . ..... .......... <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: i <br /> O <br /> JOB ADDRESS/LOCATION ..--. ( �•►..._S !J/I/ 7� •CENSUS TRACT .......................... f <br /> � .. q ...•..:......, 5� _ .._..Owner's Name ----AkleF� ...... <br /> Phone <br /> Address -•---• •----- _ City .................... ..........�._.....•.�. <br /> Contractor's <br /> _._• <br /> Name License ..........I., Phone ...... ..................... <br /> --•-_.S ._.._ ...... ... .. <br /> Installation will.serve: Residence Q Apartment Housefl Commercial OTrailerCourt 0 � <br /> Motel Q other.___:_....:.:... ..: . <br /> Number of living units:............. Number of .bedrooms ............Garbage Grinder ............. Lot Size ............................................ <br /> Water Supply: Public System and name ... ...: .............................. .........................._..-:................Private Q. <br /> Character of soil to a depth of 3 feet: Sand Q Silt 0 Clay 0 peat 0 Sandy Loam fl Clay Loam n � <br /> Hardpan Q Adobe 0 Fill Materlal............If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of systerr► in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: a septic tank or seepage pit"permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREAT [ kEFTIC TAMC ] Size.....:.............. ......................... Liquid Depth ... ......... .•....... <br /> Ca -- - Type ...:. . .......... Material...................... Na. Compartments :......... ........ <br /> Distance to nearest: Well ............Foundation ...................... Prop. Line...................... <br /> LEACHING LINE 1 No. of Lines .:..:. . .. ........ ... length of each line......-••-,•.. .. ....._ Total Length ............................ <br /> { 'D' Box .:-.-•:-__.. Type Filter Material .::. .......Depth .Fitter Material =..................................... <br /> .. Foundation .... Property Line <br /> Distance to nearest: Well .... ._... .. ... <br /> SEEPAGE PIT Depth .................... diameter Number ... .... ` Rock Fslied Yes L1 No 0.0 <br /> Water Table Depth .................................................Rock.Size .................................. . <br /> Distance to nearest:,Well .....Foundation Prop. Line <br /> -- .. ............... i <br /> (Specify Requirements} <br /> REPAIR/ADDITION(Prev. Sanitation Permit ` <br /> ........................... Date _...... } <br /> Septic Tante �:p._. /� O/ / J t .....Ao....................:p..,d ae�__✓., <br /> Disposal Field JSpecify Requirements) j _•__../� i<—.. ,P.�- .. ?,R�-_...g..G'✓ 5....._ ...i <br /> ...••... .... ................. ..._..:_......•---- .... ... •-- -6. .A..A <br /> r.. <br /> (Draw existing and requir d addition on reverse side) , <br /> Ihereby certify that I have prepared this application and that the work will beYdono in accordance with San Joaquin` <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.Distdct. Home owner or Ilten <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, t shalt not employ any person in such manner <br /> as to become subject to Workman's Compens tion laws of California." <br /> Signed .... . Zoe ="'"'_:--- Owner <br /> By --------•------------------------------ ------ ------------------------------------._._ Title .....:................ <br /> (If other than owner) <br /> >, R 96ARTMENTNSE ONLY <br /> APPLICATION ACCEPTED BY .. . .. .... ......• ......... �J'"/s�". . <br /> ' .� <br /> BUILDING PERMIT ISSUED .......:........ .......................... ._.:.._...._,_<.........DATE ... ....................... ........ <br /> ADDITIONAL•:COMMENTS ----•--•... . ... . ..................... ... ............... .--•-• ° ........:. ... ``..---:...`.:_-.... .............--------- ...------•.._.... <br /> . .... ........----• ••------- ---- ---•- -- ---•- ........ ............ ...................... <br /> ...... <br /> FinalInspection by: ....... :: .._.._ .. • . .... .. ........ ....... ... ....... ........ ....... Date 1 '/......... ................. <br /> EH 13 24 1-68 Rev. 5m SAN JOAQUIN LOCAL ALTH DISTRICT 8/7h 3H <br />