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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 36 <br /> - � y <br /> (Complete in Triplicate) Permit No. _`��__"_--- <br /> ------------------ --- ------- <br /> ------- <br /> - 111/ <br /> Date Issued //"_3"_� <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 comliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATN + 1 `- - CENSUS TRACT <br /> T _ ___.___.._____. <br /> Owner's Name" J j - - {� c�-, -UC,.k Phone <br /> i n . <br /> Address ---- Q- = `lhZL�I.�Lc, ------. City __ - -C2/1.5��Z" � <br /> Contractor's Name -- ------------------------------------------------------------- --- --------.License # ----------------------- Phone ----------------------------- <br /> Installation will serve: Residence ❑ Apartment House f-] CommercialyTrailer Court <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 ❑ Peat X Sandy Loam ❑ 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 ava lable within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK'[ Size-----_Zd ra --------- Liquid Depth ---------------- <br /> Capacity --------------__-- Type -------------------- Material---------------------- No. Compartments --v'_1.--.------- <br /> Distance to nearest: Well ____________________________________Foundaation ---------------------- Prop. Line ______________ <br /> LEACHING LINE [ ] No. of Lines __-- ---------- Length of each line_______�l3------------- Total Length ,_----D__-______________ <br /> 'D' Box ____-- ---- Type Filter Material -_____-__________Depth Filter Material _________-__-____------------------------- <br /> Distance to nearest: Well ------------------------ Foundation --------- -------------- Property Line ________________________ <br /> SEEPAGE PIT [ j Depth -------------------- Diameter ---------------- Number --_ ----------------------- Rock Filled Yes © No i❑ <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) -------------------- ----------------------------------------------------------------•----------------------------- <br /> DisposalField (Specify Requirements) --------------------------------------------------------------------------- ------- ------------------- ----------- <br /> y.s ______ _-__-____sfoz_v4___ � - ,� -____ _ , . ____ ____ __ _ _ ________ <br /> -- --------,----Yo-------------------------------------------------------- - <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 -flip-performance a work for which this permit is issued, I shall not employ any person in such manner <br /> as to bco b'ectlo Workman s C mpensation lawsCblifornia." <br /> „- enc-- <br /> Signed ---� - - -- -- -------f-- ------------ _ ---------�------ Owner <br /> By - - - --- - '----------- f -------------------------------------------- Title ---------- -°/ <br /> ---------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----C-'--�t---- - DATE _ V <br /> ------------------ <br /> BUILDINGPERMIT ISSUED --------------------------------------- ---------------------------------------------------------DATE - - --- ------- --------------- <br /> ADDITIONAL COMMENTS --------------- <br /> ------I-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- ------------------- --------------------------- ------------------------------------ ----------------------------------------------------------- ------------------------ <br /> ----------------------------- <br /> Final Inspection by: - - ----------------------- Dat-_e / <br /> Z <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />