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7��-_ <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> /- — / /V.. ,00 Permit No. --_--- -- -- <br /> (Complete in Triplicate)42 �— 5 <br /> { _________J----------01-- ------------- <br /> _________________ This Permit Expires 1 Year From Date Issued <br /> Date Issued ��_'J.- . <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 Ordinanc No. 549 and existing Rules and Regulations: <br /> F � j 4•F 7� <br /> JOB ADDRESS/LOCATION 7— - ------- -- ---:-- ------------------CENSUS TRACrTfl------_-�-- <br /> ' <br /> --- ---------- - ------------------ ` - -----------_Phone Z <br /> Owners Name <br /> Address --------f� Y -------I------�--` a F <br /> cit --�-- f' <br /> Contractor's Name ---------- -- ---- --- ----- -- - ----- ---- 1� -------.License # _1Q� ��---- Phone <br /> Installation will serve: Residence❑Apartment House❑'Commercial-:❑Trailer Court ;❑ <br /> 1 1A, <br /> %4motel ❑Other -------- ----------------------- ---------- � <br /> Number of living units:-__ --- -- Numberofrbedrooms __�__Garbage Grinder .--_ ___ Lot Size ... &s-XA_,_Q_.__--..-__. <br /> I I --------f--------------------------------------------- ----------------------------------------- ------Private <br /> Water Supply: Public System and name <br /> f IY: <br /> t <br /> Character of soil to a depth of 3 feet: Sand ❑—lSilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.❑ <br /> Hardpan ❑ Adobe Fill Material ------------ If yes, type ------------- --L.% <br /> k Al <br /> (Plot plan, showing si e16f�lot;Il ocation of system in relation to wells, buildings, etc. must be placed on treve1se side.) <br /> A <br /> NEW INSTALLATION: (No sept.tank_or_seeparge pit permitted if public sewer is available within 200" J <br /> • ! t ! ( ` Zf// <br /> � � vv <br /> PACKAGE TREATMENT [ jr—SEPTIC <br /> -SEPTIC TANK'[ �"-"� Si e------/--___l�lQ_________•----_------- Liquid Depth -----c ----------- <br /> Copacity 1-, Type _ _ _ Material_ _ - No,, Compartments <br /> --- -- ------- I Prop. �e--14------------- . <br /> ----- --- ---- <br /> F Foundation Total3 � / d <br /> LEACHING LINE Not of Lines nearest: W�I �Ler�h�of each line �� Length Line ______________ :. <br /> D' Box -_- .____._ T e Filter Material _ _ _-__ Depth Filter Material _____ _�______.__------------------ <br /> Distance to nearest: Well:_ _. -Foundation -------/-V--/ Property Line: _s__.-... <br /> SEEPAGE PIT t�1�Depth ------;2_S.-------- Diameter Numbe, ------------ Rock Filled Yes ; No i(] <br /> W�terr Table 'Depth ---------------------------------------- k Rock Size ��f �-- <br /> a --"- 1 <br />+ Drstance to nearest: Well ---------- ----------------- Foundation -__f0-_--___- Prop Llne ...../0 <br /> REPAIR/ADDITION{Prey Sanitation Permit# '1:iJr-�------------�-- Date __________________________________)/ � <br /> Septic Tank (Specify Recluir.eMentf) -------- ---- ----------------k 4------------------------------ ------------------f/-------.- <---------------------------- <br /> Disposal Field (Specify !Requirements) ----------------------_--_-______._.________----___ <br /> 1 <br /> and required_addition-- -------------- ------ <br /> '- i Draw existing, n revers.e`"side) <br /> I hereby certify that I have prepared this application and that the workI will`be done ;in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Jopquin local Health District. Home owner or licen- <br /> sed agents signature certifies the following: i <br /> "I certify that,in the"performance of the work for which this permit is,.is"sued, 1 shall not employ any person in such manner <br /> as to become subjectto.Workman's``,.Corripensati.on laws of California." <br /> AP I .. <br /> ! ) <br /> Signed ------------ `f- , `fit-- --------------- ----- T <br /> - ' ` -- --- ----------------------- <br /> _-----_ ------------ � Owner, <br /> . .� <br /> -- - r+ -' ) a .1 I f-- � Itle - -- Y r f fi <br /> BY ----------- --- . r <br /> 1 f of hon owner <br /> t .F,OR DEPARTMENT USE ONLY ' <br /> I APPLICATION ACCEPTED BY . _______ ___ --------------- DATE ----------7---.----__-___-- <br /> ------ <br /> BUILDING PERMIT ISSUED DATE i <br /> ADDIT]ONAL*C-OMMENTS-- -.-:_-_�----=----- ----- ---------—------------------ -- ---------------------------------------------- <br /> r. r , <br /> ---- <br /> _ ._ --------------- [ -�----------- <br /> } -- -- -- <br /> Inspection by. ------- ------------------- ----- -- -------- Date ---.1 .O ---- ----------- <br /> Final <br /> SAN JOA QUIN LOCAL HEALTH DISTRICT <br /> E-H:9 1-'68 Rev. 5M _ f <br />