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R <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> r-- , q <br /> ------ Permit No.7 <br /> ~ i (Complete in Triplicate) <br /> ------------------------ <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 Regulations: <br /> �, -�10_w <br /> JOB ADDRESS/LOCATIO CENSUS TRACT ____..................___. <br /> Owner's Name2�Q ------ -------------- ----- -Phone <br /> Address 'J == - - - --------- - City _ <br /> __ - <br /> Contractor's Name -----___._-_ .- --- ----�- � -----------------------License ------- Phone W6_ 5;',lQ�• <br /> Installation will serve: Residence Apartment House❑ Commercial [Frailer Court ;❑ <br /> Motel ❑Other -------------------------------------------- 4 <br /> Number of living units:._f-------- Number of bedrooms ___.Garbage Grinder _________ Lot Size _-_-_-________ <br /> Water Supply: Public System and name ---------------------- -----•----••------------•------------ ------------------------ ----------- -------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand []- Sift❑ Clay ❑ Peat❑ Sandy Loam ,E] Clay Loam :❑ <br /> .Hardpan E] - :Adobe` ""-FiII'Nlaterial If yes, tape`__--------------- � <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc-!t must bb placed on reverse side.) r <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer ii available within 200 feet,) <br /> i <br /> PACKAGE TREATMENT [ j' _,SEPTIC.TANK f' -] Size_____________________ --- Liquid Depth -______________.___-. <br /> Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ------ ---------- <br /> Distance to nearest: Well ____________-.._-_________________Foundation ---------------------- Prop. Line --------------:........ • <br /> LEACHING LINE [ j No. of Lines ------------------------ Length of each line-.-------------------------- Total Length ------ ---------------------- <br /> r <br /> 'D'r Box ------------ Type Filter`Material ____________________Depth Filter Material ----------------------- <br /> Distance to nearest. Well ___.`___.___._________ Foundation ________________________ Property Line ___.____________-_-----_ <br /> SEEPAGE PIT [ ] Depth __________ ________ Diameter _______________- Number .__..____ ______.__._.._-_ Rock Filled Yes'[ No ❑ <br /> i <br /> Water Table ''Dep#h--------------------------------------------------. Rock Size -------------------------------- <br /> Distance;to nearest:,Weli4#_____________________1_---------------Foundation -------------------- Prop. Line ______--__.---_-__ <br /> REPAI[t/ADDITION(Prev. Sanitation Permit# _.``-- _------- ------------ Date ------____________________________} <br /> Septic Tank`(Specify Requirements) ------------ --------': -------'------ ----©C------------ ------------- 4 <br /> Disposal Field (Specify. Requirements) --- J # .4 r <br /> l�'�""� ------------ <br /> ---- <br /> -------------------------------------------- ----- - -------------- ---- -- - ------- - ----- - - --- ---� <br /> ��. <br /> s (Draw existingand re uiYed addition In reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with 3an'Joaquin <br /> County Ordinances, State• L , and Rules and Regulations of th'e'-;San;Joaquin Locaf Health District. Home owner or licen- <br /> sed agents signature certifies <br /> aws.the following: ; <br /> 1 t <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 /> BY �� - <br /> Title '` ------------ <br /> (if other n owner) ` <br /> F R DEPARTMENT USE ONLY AIM <br /> APPLICATION ACCEPTED BY --lilt ------------------------------ ------------------------------- DATE = 7 <br /> BUILDING PERMIT ISSUED ' ------------------------------------- DATE ' <br /> ADDITIONAL COMMENTS -------- --- ------------------------------------------- ----------- ---------------------- ------------------------------------------------- <br /> f=— Y ----- L I-- ----- ---- ------------------_---------- <br /> ------ <br /> ---------------------------------- ----- ---- - --� - <br /> _________________________________- _ ----- _______ _ -----------------------_-----------.-------------------.------------- --------------------- <br /> Final <br /> ___.___- _ ___-Final Inspection by: -------.;; f -------------------------------------------Date <br /> T T SAN JOAQUIN LOCAL -HEALTH DISTRICT— <br /> E. <br /> ISTRICT E. H. 9 1-'68 Re M� 4 - <br />