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-�F. <br />FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />--------------------------(Complete in Triplicate) <br />Permit No. <br />----- <br />: Date Issued°� .. <br />This Permit Expires 1 Year From bate Issued <br />l the work <br />Application is hereby made to the San Joaquin ,iar` Local <br />with Counalth ty rict for a permit <br />and existing Rules tand Regulations: <br />rein <br />described. This application is made.m co p / <br />. %�-l/"��Cr1,r.,:---CENSUS TRACT) <br />JOB ADDRESS/LOCATION ____aQ- <br />--------- Phone ------------------------ <br />--- <br />Owner's Name .4pfsj_-0.--- <br />V-0 3._C r.-4 ------- ---------------------- c�ty/��U :.-------- -:•------------------------------ <br />Address ___________` <br />License <br />Phone ---------------------------- <br />c # : - <br />Contractor's�Name V -C' <br />Installation will serve: Residence r! Apartment House'❑ Commercial ❑Trailer Court ;❑ <br />Motel -Other z ----------------------- <br />Number of living units:._-) ----- Number of bedrooms -----Garbage Grinder ------------ Lot Size <br />- Private ©' <br />Water Supply: Public System and name ______"------------* -f <br />Character of soil to a depth of 3 feet: Sand' Silt fl Clay E] Peat ❑ Sandy Loam El Clay -Loam <br />'� <br />Hardpan ❑ Adobe 'Q Fill Material ------------ If yes, type <br />- , <br />(Plot plan, showing size of lot, location of-�systern in relation to wells, buildings, etc. must be placed on reverse si e. <br />NEW INSTALLATION: (No septic tank -or seepage -pit permitted if public sewer is available within 200 feet,) <br />Palo <br />PACKAGE TREATMENT ] I SEPTIC TANK![-] Size____.------------------------ Liquid Depth a <br />, ,------- No. Compartments -----------------: O <br />Capacity, ".w..--------- Type Material <br />( �``"` Foundation ---------------------- Prop. Line - <br />Distance46 nearest: Well -------------------------- <br />LEACHING LINE [ ] No. of' -lines 10 <br />~----------"----- Length of each line----------------- <br />-----' Total Length ------------------------- <br />'D' Box ------------ Type Filter Material ------ -------------- Depth Filter Material --------------------•------•-------- <br />------- Property Line --------•--------------- �. <br />Distance to nearest. Well ________________________ Foundation _--------------- p tY <br />r' ;Depth -------------------- Diameter ---------------- Number _. --------------------------Rock Filled Yes ❑ No <br />SEEPAGE PIT [ ] c <br />— Water Table Depth -----------------------------------•--- -------Rock Size -------------------------------- <br />Distance <br />---------------------•- ------Distance to nearest: Well --------------------------------- <br />-------Foundation-------------------- Prop. Line-------------•------Ot <br />I-------------------------------------- ------- <br />} <br />REPAIR/ADDITION (Prev. Sanitation Permit #-------------------------------------------- Date ------------------------ <br />Septic Tank (Specify Requirements) _---__-_F / <br />Disposal Field {Specify Requirements)-------------- ____g <br />__:'-- -- <br />, y0 ------------ ------------------- <br />---------------------------------------------------w------------------------------------------------------ - <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. Homeiowner 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 />I as to beco subject to Workman's Compensation laws of California." <br />Signed . ----- ------G'�L_.�.!'���0---------------- - <br />------------------ Owner <br />--------------------------- <br />-- --------- <br />Title ----- ------------------------------------------------------------------ <br />---------- <br />a (If other than owner) <br />FO DEPARTMENT USE ONLY <br />/- <br />Gr <br />DATE ----- r 9 15---------------- <br />APPLICATION ACCEPTED BY -------------- -E ' <br />BUILDING PERMIT ISSUED -_._-.__------_.__-- - = -=--- - - - - =-- - - - - -- - - - -- -----------------=---- - - - - -- - - - - - - - - - - - - - - - - <br />C ADDITIONAL COMMENTS ---- ---------------------- - - ---------------------------•--------------- <br />r------------------------------------------------------ --------- --- ------------- ------------------------------------------------ <br />-� <br />-------------------- <br />---------------------------------- _ _ _------------ ----- ------ ---- -- ------ Date r27�-j 7%----- - --- <br />Final Inspection b <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />l E. H. 9 1-'68 Rev. 5M• <br />