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FOR OFFICE.USE: <br /> I APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No: 7 f <br /> This Permit Expires 1 Year From Date Issued Date Issued <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 Regulationst <br /> f � <br /> JOB ADDRESS/LOCATION ...... 7.J`4 .. <br /> Owner's Name R .: . .. i .:....................:.........................CENSUS TRACT f <br /> Address .................. ........... ................. .i.� ............ .,............... .....................Phan, ... ....}.R�. .7.... , <br /> Contractor's Name ............. .. City .........................._... .........._.................................. <br /> ......License <br /> ....................... :.. Phan, <br /> Installation will serve, """"-'"""--"" <br /> .............................. <br /> Residence �artment House 0 Commercial CTraller Court 0 <br /> Motel ❑Other <br /> Number of living units,............ Number of bedrooms ............Garbe.ge Grinder ... Site <br /> Water Su � <br /> - I .....,...... <br /> Supply: Public System and name .................. ...................................................... .... <br /> l <br /> . ❑ ly0 Peat� Sandy Loam 0 Clay Loomrivate � i <br /> Character f ................... <br /> o soil to a depth of 3 feet,; Sand'[] . Silt Clay <br /> :Hardpan [� <br /> p Adobe fl I=fII Material <br /> ............ If yes,type............................ � <br /> (Plot ,pian, showing size of lot, location of. system In relation to wells, buildings, etc, must be placed on reverse side.) <br /> NEW INSTALLATIONS (No septic tank or It, - rmitted if public sewer Is available within 200 feet,) <br /> - see a e,ppe p-g =. - <br /> PACKAGE TREATMENT [ ] SEPTIC TANK <br /> I Size................................. ............ Liquid Depth <br /> Capacity .................... Type .................... Material. •� .......................... � <br /> Distance ..................... No: Compartments R. <br /> to nearest, Well Foundation <br /> S LEACHING LINE ( j No. of Lines' ...................... Prop. Line .. .�............... <br /> .. Ce'ngt_of each-11he......... <br /> .D' Bax ... ,�-'. ................... ........., ........ Total Length .......................... � <br /> •• a Filter 1' <br /> Type Material:..................Depth Filter Material <br /> Distance to nearest, Well ..................'­ .... Foundation <br /> SEEPAGE PIT Property Line ...................,® <br /> ...�..��. [ ] Depth ..... <br /> ...__... Diameter <br /> ._ ............ .:.......:. ... Number .................... Rock Filled [] , <br /> ' Water Table Depth -, <br /> Ye: No <br /> .......:.:............................Rock Size ................ <br /> Distance to nearest, Well .......'....., <br /> REPAIR/ADDITION(Prev. Sanit ' ..Foundation .................... Prop. Line .................... <br /> ation'Permit# ...... � '� <br /> Septic Tank S ,4 ..................................... Date ... . .......................... .] <br /> (Specify Requirements). .'...R�ep6c'e... .1��? <br /> Disposal Field (Specify Requirements) ............................... <br /> `. ................ ..........._............f................................................._........................... j <br /> .. .................................................................................................. <br /> ..................... <br /> .raw existing and ....aid..e..]........................I.................................. <br /> required addition on revor so <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with Son 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 followsng: :� <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 /> Signed ... 2�.... ..... <br /> �................ ............. t �:�- .......... .............. Owner <br /> By �Title �.. . <br /> (If other than owner) ..........................:�� ... . *• T .................................. <br /> - .......i... <br /> ., FOR DEPARTMENT SE ONLY <br /> APPLICATION ACCEPTED 8Y .. <br /> ........... - <br /> BUILDING PERMIT ISSUED ,�' . ... . <br /> -•rit��DATE `I 30-7`� <br /> ADDITIONAL COMMENTS .,/ c�rrs,�-_ :: ......� r ....,r.: -...:::—t.T..:;'DATE _6"­­­­­.......................... <br /> :::::::..........................._ ....::...................... �•�.�:..::��:`.`.:�:��``... ..... ::............................ <br /> . <br /> Final Inspection by ....... E ............ ............ . .................................................. ... :........ <br /> .... <br /> ........ . . . <br /> ..................... ...... ..... <br /> ......................Date <br /> 'SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 241•'68 Rev. 5M <br />