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FOR 1-DFFICE USE: / <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. 7�?..-.. ... <br /> This Permit Expires I Year From bate Issued Date Issued <br /> Application is hereby made e}the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. Thi appliyatior �de�jn compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> Y rs . ., ./1/EA.,/A CENSUS TRACT ..if .. .. .......... <br /> JOB ADDRESS/LOCATION .. ���-��'��-�`:.- ..�.- � 3G �"/ 7 ,i_ <br /> Owner's Name & � .. ,.a... ............ .. ....... .... ....... ... ... .... .. ..... ......Phone .... . .... ...-..T.......- <br /> Address ... ...3.. ?4. .... .... ... .. .. ... ............ City . .. .. .... ........ . <br /> Contractor's Name .. /.its .,.�,ry. .. .. ... .. License # . . .. ... ........ Phone ..... ... <br /> Installation will serve: Residence �b Apartment House Commercial ❑Trailer Court ❑ <br /> Motel ❑Other . .. ... ... ....... .... ........... <br /> N157- <br /> umber of living units: ... 1.. Number of bedrooms .. 3. .--..Garbage Grinder 4-l". Lot Size - ... ". .. <br /> Water Supply: Public System and name ... ....... ... ....... ... .... ... .......................... ...-.....-.Private-4 <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam-P 11, <br /> _ Hard anj:� Adobe-•,❑ Fill Material ... .... .. If yes, type ....... ........ ... .. f <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 available within 200 feet,) U <br /> PACKAGE TREATMENT ) ? SEPTIC TANK�1 Size.. .u ..l.j.- '�"... -.. Liquid Depth -.�.�...------ j <br /> Capacity/4�lr`D .... Type Material.�,cr✓'-r• �,7r No. Compartments ............. <br /> ` Distance to nearest: Well .... ............... ....foundation .f O ...... ..... Prop. Line ..-:.......-....... <br /> LEACHING LINE S No. of Lines .... Length of each line ..14t� ... . ... Total Length ............... <br /> 1 'D' Box _ <br /> �. Type Filter Material /-�'1}�......--..Depth Filter Materia! ...I. ���- -�� �--�.�-.-..-�...... <br /> -.---•-- <br /> I Distance to nearest: Well ..;� Foundation .1.0. Pro Line / <br /> Property .3............. <br /> SEEPAGE PIT Depth .... Diameter .. Number �. ... ...�Rock Filled Yes No <br /> Nater Table Depth .. .4G......... .... .......... ..Rock Size ..I.' .-.....--...-- <br /> Distance to nearest: Well .. � . . ............. .Foundation /d.......-.--- Prop. Line r.-.............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..... .. ... . .. .... ....... ... . Date ................................. ) <br /> Septic Tank (Specify Requirements) ... ... ... ... .. ........ ... ... ... ........ .......... ... ................... .... .. ..... ...................... <br /> Disposal Field (Specify Requirements) ........ ... .... ... .. ... ..-........... .� ?`.7(?.. .... D:X, l�s,D „f�R10+7- 4P L1�- <br /> haR 3 T3saRoo�- Dwe�uniG"".. <br /> - .... ... ... ... . ... ... ......-�. <br /> ... ... ... .. <br /> + <br /> (Draw existing and required addition on reverse side) <br /> 1 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 Son ,Joaquin Local health District. home owner or lictn- <br /> 1 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 beco a sectto orkman's•Compensation laws of California." <br /> Signed ... <br /> .... ... .. .. ............... .... .... .... .... .... Owner <br /> By .... ... ... . . Title ... .. .. .. ... ... ... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED_BY . l,Yyl ... --. .. .. .... ... DATE .... ........... <br /> BUILDING PERMIT ISSUED ....... ... .. ..... ... ... .. .DATE ... ..... ....... ........... ... ...- <br /> ADDITIONAL COMMENTS i ... .... .. . ......... ... .. .. ... ........ .... ... ............ ....... <br /> I .... ... .. ... <br /> ... .. .. .... .... .... ... ... .. ... ... ... ... ... ... .. <br /> .... ..... <br /> Final Inspection by .(.� .......... .... .. ........ .... ......... .... .... .... ... .... ...Date . ... .- ... . . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />