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FOR OFFICE USE: T; � <br /> APPLICATION FOR� SANITATION PERMIT...............�r:.. Permit Na. .- — 9 Z ; <br /> :..................... <br /> ........... _1Cotnpleteln�Triplicatm) <br /> ........ ...... ....................................... . This p mbIxxpins 1 Year From Dow 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 madelin compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> .IOB ADDRESS/LOCATION <br /> ......................::........................... ..-.....CENSUS TRACT .......................... <br /> Owner's Name ..:... .!.!'7...._Q r-a- ... p.1'.�.......... Phone ..9..5!. '.s ..l. .. <br /> ...... <br /> Address . m.. City ... 7�0 G.l�. m.�'1......... <br /> Contractor's Name �� r t- `s�. f..S'D h.�...... ...............: ...License # 2� S!, .Y..3.. Phone d 7. <br /> Installation will serve: Residence J'Apartment House J3 Commercial OTraller Court <br /> Motel Q Other...........................:................ <br /> Number of living units:..__....--- Number of bedrooms . Garbage Grinder ............. Lot Size ....�.. ..�4. p:............. <br /> Water Supply: Public System and name ...:... ................. <br /> ......................................................................Prhrme <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay Q Peat[3. Sandy Loam 0 Clay Loam <br /> Hardpan p Adobeo Fill M6WIal ............ if yes,hype............... ............ <br /> ]Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC.TANK{ j Size......................... <br /> ....................... Liquid Depth .......... .:.. . ..�,/ <br /> Capacity ....l ---•---...... Type .................... Material...................... No. Compartments ............ . ... <br /> Distance.to nearest. Wei l .....................................Foundation ........... Prop Line <br /> LEACHING LINE [ ] No. of Lines --......I........I...... Length of each.line............................ Total Length ............................ <br /> 'D' Box .....----... Type Fi!#er Material ....._......•...___.Depth .Filter Materia) ..—........................................Q <br /> Distance to nearest, Well._.-.................:....: Foundation .................::~:`--- Property Line ........................ <br /> SEEPAGE PIT { ]: Depth .. .... Diameter Number <br /> ....---- <br /> ..�_ .. -.�........ � ,filled <br /> as o C <br /> I Water Table Depth .. `' .....Rock,Sizer- <br /> ..............•---•--...... <br /> -� - Distance to nearest:Weil- .foundation . .... Prop. Line . <br /> REPAIR/ADDITION(Prev. Sanitation Perm,t# ........ ................................ Date ......__.._.._.. ............. <br /> Septic Tank {Spec'ify Requirements): ...:._ .- ........ . . --- tiJ:1.�? ..���, , <br /> Disposal Field (Specify Requirements) f <br /> I_.._._ _ <br /> .......... ----------------­--------------­------- 1 ----•---•-------------- ---- ------- . ....... � ........... .............. <br /> _.. --- ,.. .. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and,that .Lite.work..will be done in accordance_with Sart Joaquin i <br /> County Ordinances, State Laws, and.Rules and Regulations of the San Joaquin Local Health-District. Hone owner or lice& <br /> sed agents signature certifies the following: <br /> I <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any perm In-such manner <br /> as to become subject to Workman's Compensation laws of California." # <br /> Signed _... .._.... - Owner <br /> BY ---- itle <br /> - ----- --- ....:.................. <br /> ... <br /> f.a#her than owners <br /> DEPARTMENT_USE ONLY--:. . <br /> APPCiCATION"ACCEPTED BY _. ? ' <br /> BUILDING'PERMIT ISSUED .. ....DATE ................... ......._.......-------- i. <br /> ADDITIONAL COMMENTS .- _ - ' . -- .. <br /> . <br /> --- -------------------- --- <br /> ---••--------------- --•------.._...---------- -- ...........-----------------------------------................. <br /> ._.. <br /> Final Inspection by: .......... - Date `� <br /> EH 13 .2b 1-68 1 �` - •- ��{ ......_ .. <br /> AN J UJN LOCAL HEALTH DISTRICT 8/711 3M <br /> ` o 1 <br /> l <br />