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FOR OFFICE USE: *. - <br /> f_e�1 -— <br /> Z . APPLIC&IO '�FOR SANITATION PERMIT <br /> ----�t-�y--- <br /> 1- -_------ � � hIPermit No. <br /> (Complete in Triplicate) <br /> ------ ------ ----------- <br /> //�� [[ Date Issued __ _ _-____-_-- <br /> __________-________._!7._�lJ _____.____ 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/LOCATION .__ :_ _ _ _ -�__ ____.__ -______�_Q___.______._____CENSUS TRACT _.__________.._ <br /> 1� Q .......... <br /> Owner's Name -----IOAA)---- 5----- / �f*-:. `!� �'��� , 1 / -------------- `------------ Phone --- <br /> Address <br /> -Address -----,�r��� �- S_,o0/<Z,,4,0------� -------------------- City --- ------------------------------------------ <br /> Contractor's Name ___ A <br /> /�►6-��-----�CJ�-�-�°'-- —----------------------------------License # ..Phone <br /> Installation will serve: Residence [�partment 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❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan 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__ X , _15'��__________ Liquid Depth ___ _6............... <br /> .� iCapacit __ _ Type XoJ��__� �_ Material__________________`` No. Compartments ---- <br /> Distance to nearest: Well ______________________________Fouenddation !_©____________ Prop. Line ----� /-______ <br /> LEACHING LINE [ ] No. of.Lines - --64----_----_--- Length of each line_- _715-_715_ t g <br /> __ Total Length _.1�__�_____________ <br /> a y� <br /> 'D' Box -_1------- Type Filter Material � ._ �,Depth Filter Material __/��................................. { <br /> Distance to neyrest: Well ______________ ______ Foundation Property Line, ________________ ______ <br /> SEEPAGE PIT [ ) Depth ___AO_________ Diameter �T__ Number _________�a' ___________ Rock Filled' Yes ' o C1 <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- 1 <br /> Distance to nearest: Well ________________________________________Foundation --------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------_-_-_---- <br /> Septic <br /> _____________--._ -_.._..____Se tic Tank (Specify Requirements) ------------------------------------------ ------- ------ r <br /> Disposal Field (Specify Requirements) ___-________ ----------------------- <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 /> "1 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 subject to Wor mans ompens on laws of California. <br /> Signed ------- k�- - ------------------------------ Owner <br /> By ------------------------ ------------------------------------------------- ------ Title ----------------------------------------- ------------------------------ <br /> (If other than owner) <br /> tp EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- --- ---------------------------------------------------------- DATE --- G-�777/f':112 --------- <br /> BUILDING PERMIT ISSUED ---- - -- - - - - ---DATE ------------------------------------------- <br /> - - -- - - --------- -------------------- <br /> ADDITIONAL COM TS a f <br /> p ---- <br /> �-' ------------ <br /> ------ --- ------------------------------------------------------------------- --- I <br /> --- - -- -------------- --------------- - - <br /> Final Inspection by: _ — V <br /> ----- -- -- - -----------------------------------------------------------------------------------Date = ' <br /> JOAQUIN LOCAL HEALTH DISTRICT 3 <br /> E. H. 9 '*J-'68 ev. 5M �'_ <br />