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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � �P <br />,.......... <br /> .................................. <br /> Permit No. ..7 .......... <br /> (Complete in Triplicate) <br /> ThisPermit Expires 1 Year From Data Issued c� <br /> Date Issued . ..'.l `�.7. <br /> Application is hereby trade to the San Joaquin Local Health District for a permit to construct and install the work here n F <br /> described. This &I , Pa in compliant with nt Ordi me Na. 544 and existing Rules an ulaticn <br /> ' <br /> JOS ADDRES <br /> i�5U <br /> Owner's Name. ..:-.... • , •----- a�`�, ---------- ................ ..:. ..............Phone •-------- .............. <br /> Address __.....------- --•- . ./11,/ /. ................:......... City .�......------•--• ........................................... <br /> �. Contractor's Name .----.. .. :�-.......... :. ----------------•-----License #_- l��.1....... Phone'.`� F.� /_V/ <br /> Instailation will serve: Residence partment House C] Commercial []Trailer Court 0, � <br /> Motel ❑Other ' <br /> --- <br /> ` <br /> 'Number of living unity....--�..--.Number of bedrooms '..Garbage Grinder . . Lot Size :................................:.......... i <br /> • <br /> Water Supply: Public System and name .............. i ;.................Private <br /> Character of sol! to.a <br /> > r. deeth of 3 feet:-. Sand 0 Silt lCaY Sand, <br /> Loam <br /> fl 1 Clay Loam <br /> AdeHand an_[]_ -Ifyes,type <br /> j] <br /> ' ` <br /> (Plot plan, snowing 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 [ ] ASEPTIC TANK' - �w--E ' e......... ,,l.... .......... Liquid Depth <br /> Capacity -�-- -- ---------- Type .- - - - -., Materia -- -:..... No. Compartments B----------- � <br /> Distance to nearest: Well ..... 1.---•.. ............Foundation Prop. Line ................. <br /> LEACHING LINE a No. of Lines. Q - _ <br /> -------- •--•--. ------- Length of line,.,�� t7Tofa) lengt_ - -Qw,/ .. <br /> 'D' Box .--- -S Type Filter Material f?.: :Depth—Filter -material _...��--•.........................:... <br /> p r <br /> - Distance o nearest-Well .-.-...x.!�._�._:._. Foundation ...:. ..... Property Line ........... <br /> SEEPAGE PIT [ Depth ._ ,_.-_. Diamet r .. „ �!_..._ Number .. Rock Filled Yes No <br /> Water Table)Depth ---------- ............... .:.....•..__....Rock Slze --f._ 7 ......... <br /> Distance to nearest: Well ....-.. ( Foundation --./Q__•'.. Pro Line ...•� .............. <br /> .......•-- P• <br /> REPAIR/ADDIT'ION'(Prev. Sanitation Permit` .....____...................--------- Date................................... <br /> Septic Tank (Specify Requirements) ------------ --•----...-•---•--•--•---•--....................... ................................................---------................. <br /> . <br /> DisposalField (Specify Requirements} .......................................... ...................................... ------------................._... ...... <br /> ......................................................•••-----......-------------...-----••----•....---•-----•••--......._....•-•--.._......------------......._......_..._.__.--------• ---- <br /> + 4 � <br /> , 7 -11.......................... .............................. ...................... --------------P�7 <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances,.State'I.aws,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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." l <br /> Signed -------------- ......-----• Owner <br /> By ------ ---- Title ....... .. ._ ly. <br /> (If a than ownefl., <br /> R DEPARTMENT USE ON <br /> APPLICATION ACCEPTED i;^ <br /> ............... .... . .. . ..... .. .. DDA—TE ...... J J <br /> t t I.r'r�f' TE ��"%"�� ..------. <br /> BUILDING PERMIT.ISSUED <br /> ADDITIONAL_ COMMENTS - --"'•--""- ..................................................... <br /> -----------------------....... ----------------------------------------------------------------------------------------------------- --•----•-- ------------ <br /> ..................... --------.................• . .................................... .......... <br /> Final Inspection by ---=----------- f .Date . � ... ......-.._. <br /> �. .... ............... ............................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT l <br /> E. H. 3.3. 24 1-'68 Rev. 5M s '' 7/723 M <br />