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FOR OFFICE USE: <br /> Il APPLICATION 'FOR SANITATION PERMIT <br /> ----- -------------------- -------------- ----------I---- Permit No. <br /> 0 (Complete in Triplicate) <br /> ---------- --- II G`/6 Y <br /> �l This Permit Expires 1 Year From Date Issued Date Issued _.�---___-"1_. <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 applicati is de in comphan with County Ordinance No. 549 and existing IZFIesZ' ind R ulations: <br /> � �li �` -.� CEN kACT . <br /> JOB ADDRESS/LO TION ir., L - �- <br /> Owner's Name ------ !,' 1 -------- ------------ ----------------- ---- --Phone _--------------------_--.- ------- <br /> p� <br /> Address _ - _.City _---------- ---- <br /> Contractor's Name ° ------------------------------License 5---- Phone �°' - f <br /> Installation will serve: Residence partm nt House❑ Commercial 0Trailer Court F <br /> Number of bedrooms ___ Garba a Grind E <br /> g Motel ❑Other . <br /> Number of living units:-___J- .- __-- i er4 --_- Lot Size '�� -- -�-�-�'-------- <br /> Water Supply: Public System and name --------------------------- { -.------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silti❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ /. <br /> gg if es, type Hardpan ❑ Adobe Fill Material --1 _-_- y yp 2 <br /> (Plot plan, showing size of lot, location of system i(n relation to wells, buildings, etc. must be placed on reverse side.) <br /> i o septic tank or seepage pit permitted if public sewer is available within 200 feet,) �,( <br /> NEW INSTALLATION: (N" / ` <br /> PACKAGE TREATMENT { ] SEPTIC TANK ize_�/��_� .--_------------------------ Liquid Depth ____- ------------- <br /> - <br /> ---_-------- W <br /> i �, �._-:}_ ...,...�. ....�.� - - ---- ,�,�' No. Compartments - - -----•----•` <br /> r D" pacitY ---- - - TYPe ---'�-- --- - Materia -, - • -- ----_-- <br /> t <br /> Ca Foundation ___ --0 -i -_---__ Pro Line �J------------- Q <br /> tante to nearest: Well -------�-------------------- %- � --- p• <br /> LEACHING LINE No. of Lines _��--------------- Length of each line)_ca)__1A�---- Total Len th r ----__--- <br /> 'D' <br /> _-_.. _--- <br /> D' Boxrearest. <br /> TYPe Filter Material -- -- ; p Material -_-• ------....-•--------------- <br /> -------------- <br /> -Dista.l� 1 5,. - De thYFlter 1 <br /> 1 �.-f' Pro S <br /> te Well ...... _._--__--Foundation --- ,___ pert) Line <br /> -- <br /> SEEPAGE PIT [ Depth ---------------- Diamet r _. . .Number --.--.__-` ,____ Rock Filled Yes M.__�o C <br /> �k --- ..Rock Sizei- <br /> ' Water Table Depth '�- •. <br /> Distance to nearest: Well --- _ -'----------­------------Foundation ---�l--C?--------- Prop. Line ------- <br /> Sanitation Permit# -----•--------- ---------------------- Date -------------------- ------------) <br /> REPAIR/ADDITION(Prev. S' <br /> = <br /> Septic Tank (Specify Req <br /> Disposal Field (Specify Requirements) ------------------- ---------g---==-- __=_------- --`- --------------------------•------------------------------ '. <br /> I � . <br /> ----------------- --- --------------------------------------------------------- --------- ----------------------------- -------------•--- <br /> -------------------�-` -r ---------------------------------------- <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 /> } <br /> sed agents signature certifies the following: y <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." F �I <br /> Signed ------------------------ -- Owner <br /> BY ------------- ~- rTi#le - --- ------- ---------------------- <br /> (If oth r thao ner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 'iY . ----------------------------------------- ---- DATE -------------- <br /> BUILDINGPERMIT ISSUED---- ----- -------------------------------------------------------- -------------------- -==n-----------.DATE --------------- <br /> "------- <br /> ----------- <br /> ADDIT AL --------- <br /> -------------- <br /> ,A { <br /> II - ---- <br /> -------------'----------------- ----------------------- - - ----- -- ------- ----- -------------- <br /> Final Inspection by: ----------------- ------------ Date <br /> N JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M ~ <br />