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-:sFOR OFFICE USE: <br /> COX APPLICATION FOR SANITATION PERMIT <br /> --- --:�-S-7 -­-----&- --- - Permit No. <br /> 2- ;L� _(Complete in Triplicated <br /> --- ---------- <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> ----------- ---- 7--------------- <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 /> --sacro <br /> JOB ADDRESS/LOCATION ...--._1---00--l.--. —,�........ -----------------------Phone-----------------CENSUS TRACT ---s --------- <br /> - ------------- -------- <br /> Owner's Name ----------- <br /> - -- ------------- ----------------------------­----- <br /> Address ------------------- --------- - City <br /> - <br /> C-51 License icen ---- Phone 4&/ <br /> Contractor's Name 0- <br /> ---------------- <br /> Installation will serve. Residence .Apartment Rouse.F.;Commiercial-oTrailer Court [3 <br /> M6tel E]Other -------------------------------'=---------- <br /> -----------f-------------- <br /> Number of living units:--_ ----- Number of beclrooms.t----- ---Gairbj�'ge Grinder ------------ Lot Size ----------------- ------------- ------ <br /> Water Supply: Public System0 <br /> bnd name ----------------------------- -= ----------------------------`--------------------------------------------Private El <br /> Character of soil to a depth of 3 feet: Sand Silt 0 Clay,EJ Peat E] Sandy Loam I Clay Loam El <br /> Hardpan E] Adobe Fill Mate ial ------------- If yes,type --------------_---_------- <br /> (Plot plan, showing size of lot, loc6tioh.: of system in-rel.atioh,,,toewells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic­tqk or seepage pit permitted-if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TAN I Kf Siz,e----------------------------- ------------------ Liquid Depth -------------------------- <br /> Capdcity -------------------- Type ------- ---- Material----------- -------- <br /> -- Mt <br /> -------- No. Compartments ------ ------­------- <br /> DistaDistci <br /> nce to nearest; Well -------------------- -----______Foundation ---------------------- Prop, Line ---------------------- <br /> LEACHING LINE No. of Lines ---------------I--------- -------- Total Length ----------------------------- <br /> 'D' B' x ------------ Type Filter Material ---------------------Depth Filter;Material -------------------- ------------------------ <br /> Distance to nearest- Well --------A--- -_---_ Foundation'. --------------T----------- Property Line. ------------------------ <br /> SEEPAGE PIT Depth '1:------- Diameter ---------------- 'Number ------- ---------- ---------- Rock Filled Yes E] No 0 <br /> Water TA16:,belpth ------------------------------------------ ize --------------------------- <br /> Foun ation --------------------- Prop. Line----------------------- <br /> Distance to nearest: Well ---------------------------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------- ------ --------------------- ------- Date ------------i---------------------} <br /> - <br /> I <br /> Septic Tank.(Specify Requirements) '---------- ' ----------------------- ­ '' - ------------------------ <br /> Disposal <br /> -----------------------DisposaI Field Specify R--e--q- v--i-r-e-- <br /> me I T <br /> s J�---- ----- -------- ---------- <br /> -- -------------------------------------------- ----------- <br /> ------------------- ---------- - ---------f--- ------------------------ Z -------------- <br /> -existing-.an requ re <br /> -0 <br /> re <br /> ,,­�(Draw. I d addition on reverse sid. <br /> certify that rep. <br /> I hereby I have 6red 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 Hedith District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> 4 <br /> "I certify that in the performance of the work for which this permit is issued, I shall n01-imploy any person in such manner <br /> as to become subject to Workman's Compensation laws�T(Za-11(o—rn1ci-.`-- <br /> Signed --------------------- -- ------------- - -------- -- --------------------------------. Owner <br /> ----------- ----------- - --------- ----------------------------------- <br /> --- -- --------- -------------- -- -------------------------------------------- Title -- <br /> ' <br /> �i -)ot he an owner) <br /> By ------- <br /> FOR-DEPARTMENT'-USE-ONLY--.- <br /> 1 .1, <br /> APPLICATION ACCEPTED BY -------I-----1 `N--------------L-------- --------------- --------------------------- DATE -------~-.-----� --------------------------- <br /> BUILDINGPERMIT ISSUED ----C-.N-------------- ----- ----------- ------ ---------------------DATE ---------------------------- -------------- <br /> ADDITIONAL COMMENTS ---------------------A <br /> ------------------------------------ --------------------- ----------------------------------------------------------- ---- --- <br /> ------------------- ------- <br /> - -------------------------- --------------- -----------)----------------------------------------- -------- ---------------------------------------------------- ----------------- - -( <br /> --------------------------------- ------ --------------------------------------------------------- ---------------------------- ------------------------------------- <br /> - ------------- ------------- ------------------- ----------------- - ------4 - <br /> Final ln-peiiion by: - --------------- ---.D t -------------- <br /> --- ------ ------ ---- -- -------- - <br /> SAN JOA QU I N LOCAL HEALTH DIS TRICT <br /> E. H. 9 1-'68 Rev. 5M <br />