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r ii <br /> FOR OFFICE USE: - <br /> .. APPLICATION FOR SANITATION PERMIT 7 <br /> --- - �-------•------ _f__�-:-�--�`..� <br /> (Complete in Triplicate) Permit No: <br /> ---------=--------- -- - -------------------- <br /> ------- <br /> - - - ! <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> "A) : �� 1 eV -r 2-- <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 op I'I'cation is made in co lionce with County Ordinance No. 549 and existing Rules and Regulations: <br /> --Z D `� 'u. 3 e�Tr arm <br /> JOB ADDRESS/LOCATION -----CENSUS TRACT -------------------------- <br /> Owner's Name _ fir - - ----- -- ----•---••-------------- Phone <br /> Address - B_ C' , - -------------------------------- CityG1�- A�1.�4----------------------------------------------.._. <br /> Contractor's Name __. -- -------------_------1� ------------------- --License # Yt3rlcc - Phone <br /> Installation will serve: Residence ❑Apartment House ❑ Commercial❑Trailer Court i❑ <br /> Motel ❑ Other -------------------------------------------- i. <br /> Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------- Lot Size _._---_--___-___----_------_____-___-___- <br /> Water Supply: Public System and name -------------------------------------------------------------------------- '.•--------------- <br /> ________________Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt-0 Clay ❑ Peat❑ Sandy;Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- <br /> (Phot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (7 septic <br /> tank or <br /> TANK seepage pit permitted if public available within 200 feet,) �r <br /> PACKAGE TREATMENT f ] ,� -- -___-____ Liquid Depth __�lk------- .-_- i <br /> Capacity /.Plop -_-_ Type Material-�_ No. Compartments ................ <br /> Distance to nearest: Well --- -------------------- -O_�_ <br /> -- -------------�- - ----- Prop. Line --�-------------- I <br /> LEACHING LINE [ J No. of Lines ---1_? -------------- Length of each lineFoun�da�tion Total Length ,115/0------------- <br /> 'D' <br /> . .._______'D' Box ------------ Type Filter Material _ - ___Depth Filter Material ---1R"Y--------------______....... <br /> ____ <br /> -+ <br /> Distance to nearest: Well ----C�_D_ __---_ Foundation ------- -- Property Line. _s�#o.............. <br /> SEEPAGE PIT [ ] 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 /> Disposal Field (Specify Requirements) ------------------------------------------------------ -' --------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ <br /> _. _. <br /> ______________________ ___________________ _ _ ___________---------- <br /> ---------------------------------------------------------il-------------------- ------------------------- <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 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 Workman's Compensation laws of California." <br /> SignedOwner <br /> -------------------------- <br /> -------------- -------- <br /> By -------------- -_ Title - --------------------- <br /> ---- - ------ ----------------- <br /> (if other than owner) <br /> FOR DEPARTMENT YSERyq <br /> APPLICATION ACCEPTED BY ---------------------------- DATE 2 <br /> BUILDING PERMIT--,ISSUED -------- =- ---DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS i <br /> --------------------------- <br /> ----------- -------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ f <br /> ------ ----------------------------------------------------------------------------- ---------------------------------- <br /> ------------------------------ -------------------------------------------------------------------------------------------- --- <br /> ----- -- - - -- <br /> Final Inspection by: ------------------------------------------------------------------------------------ ------ -- --------Date ----- ------ I <br /> SAN JOAQUIN LOCAL HEALTH TRICT I <br /> E. H. 9 1-'68 Rev. 5M �(J <br />