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F0R,C1FFI- , <br /> CE USE- - -._: APPLICATION FOR SANITATION PERMIT Permit Na. 7�"_7.7�. <br /> - - <br /> ------------------- - ---- •- - -- . <br /> (Complete in Triplicate) <br /> Date Issued . .� ---_-�• <br /> -------------_-----_----------------------_--_------_ This Permit Expires Year From 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 Regulations: <br /> <2-7T 5 5,.# /�. 0 /J� tnU--o�1 <br /> JOB ADDRESS/LOCATION .� - - -----1-�/} - l'�t CENSUS TRACT -------------------------- 1 <br /> Owner's Name --- - ---------------- -'{XX_�_ -------------- --------- - Phoneyl _�rf� S�7 <br /> Address - -----------------------------•- City _ ..7_... <br /> Confiractor's Nameow1---------------License # Phone /• <br /> Installation will serve: Residence ❑ Apartment House-E) Commercial .%Trailer Court ❑ 9' <br /> Motel ❑Other -___.�wss!/-Ta�-___-.-- U1 <br /> Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------ Lot Size ..___--_______-_--______--________-_-____- <br /> Water Supply: Public System and name ------------- -----------------•------------------------------------------------------------------------------Private ❑ �A <br /> Character of soil to a depth of 3 feet: Sand'j] Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ UI <br /> Hardpan Adobe ❑ Fill Material ----______-_ If yes,type _------------- �' <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 [ I SEPTIC TANK'f ] Size------------------------------------------------- Liquid Depth -----------------.---.----- <br /> CapacitY -------------------- Type -------------------- Material----- ---------------- No. Compartments -------•-----------•-- <br /> Distance to nearest: Well -----------------------•---------_Foundation _.-------------------- Prop. Line -_------------------•- <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ---------------------------- <br /> 'D' Box --------- Type Filter Material _-_____________----Depth Filter Material --------------------.----------.-----._----- ` <br /> Distance to nearest: Well ._____ - <br /> __- _____________`Foundation -- Property Line ---_-_________--__._-___ (w <br /> SEEPAGE PIT [ ] Depth ____ Rock Filled Yes No <br /> -------------------- Diameter -------------- . Number ---- - ---------------- ❑ 0 <br /> WaterTable Depth ------- ----------------------------------------Rock Size ---------------------- --------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------- -- Prop. Line ..-------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) ------------------ ---------------------------------------------------------- .-------------------------. <br /> �f 'le r J � L <br /> Disposal Field (Specify Requirements) ------- Y 7------------ '? " t <br /> ----------------------------------------------------------------------------3------------------------------------------------------------------------------------------------------------------------------ <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. Home owner 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 /> as to become subject to Workman's Compensation laws of California." <br /> Signed ---------------- ------------- ----- Owner <br /> BYTitle --- ---- r--------------------------------------------- <br /> (If other n owned <br /> FOR DEPARTMEW USE ONLY <br /> APPLICATION ACCEPTED BY ---------- --- ------------ ------ ------------ DATE7i-------------------- <br /> BUILDING PERMIT ISSUED ------------------------------------ --------- ---------------- -- - ----------------------DATE <br /> ADDITIONAL COMMENTS ------------------------ ------------- -- ••------------------ - <br /> ---------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ------------------------------------------- <br /> -------- ------------ <br /> ------ --- - -- <br /> ---- <br /> ----------------------- <br /> Finai Inspection by ------ ------ ---- -- -------- - --- -- Date <br /> SAN JOAQUIIv LOCAL HEALT ISTRICT <br /> E. H. 9 1-'68 Rev, 5M L <br />