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'FOR OFFICE USE:- f APPLICATION FOR SANITATION PERMIT <br /> --------------- ----------------------------------- Permit No. 7�_ <br /> t. (Complete in Triplicate) <br /> ----------------------------------------------------- -- <br /> Date Issued <br /> ---------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joa uin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in com liance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB.ADDRESS/LOCATION �C_.LL�---- -----QL1et-�$- + --------------------------------- CENSUS TRACT -------------- ------ r <br /> Owner's Name -. �'i A �'------------ ------ -- ----------------------------------- -------------------Phone -- �ur�!iu�N------------- <br /> Address - ------� t�e'--------------------- -- - -------------------------- City ---SLK------------------ ---- ----------------------------- ---------- <br /> Contractor's Name _ _ 7------------------------- License # Phone <br /> Installation will serve: Residence Apartment House-[] Commercial :❑Trailer Court i❑ <br /> Motel F-1 Other -------------------------------------------- <br /> Number of living units:---- 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'❑ Silt❑ Clay Peat ❑ Sandy Loam -❑ Clay Loam ❑ <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,) �r <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------------------------------------------------ Liquid Depth -----____.-------------_ <br /> Capacity CA--- Type s Material__)�&A--_ No. Compartments ---<9-- ------------ Q <br /> l __ Pro Line _-- <br /> Distance to nearest: Well - ( 11-t'. -----------Foundation ___� ------___ p. ______________ <br /> -Oor / <br /> ,. LFAE�I1NG LINE [ ] No. of Lines - g1 �- 9 <br /> ------------ ---- en th of each line------- 0---------------- Total Length -aJ' -__.---------------- <br /> // / <br /> D' Box ---Y______ Type Filte Material _ �- --Depth Filter Material --_-�------ -------------------------- <br /> 'Distance to nearest: Wet - ----!` -R1� Foundation __A0---------------- Property Line ------.-------- <br /> SEEPAGE PIT [ ] Depth _- -_-,_____;.___c,. i&meter ---------------- Number -- ---------------- Rock Filled Yes ❑ No i❑ <br /> W Pt T e Dep ---------------------------- ------=---------Rock Size -------------------------------- <br /> Dista ce to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------------------. -- <br /> REPAIR/ADDITION(Prev. Sanitb`tion P`eerrmit# -----------------------------_- Date ---------------------------------- <br /> SepticTank (Specify Require�i�3'------------------ --------------------------------------------------------------•-------------------------------------------------------_ <br /> Disposal Field (Specify Requirements) ------------- - ---------------------------------------------------------------- <br /> a. ------------------------------- ----------------------------------------------------------------------------- <br /> ------------------- --------------------------------------------------------- - <br /> (Draw existing and required additidn 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 th in the performance of-e work for which this permit is issued, I shall not employ any person in such manner <br /> as to beco ubject to r an s C me sation laws of California. <br /> Signed\-- �IU`'L:- -- - - -------- - - Owner <br /> By ------------------------------------------- ---- Title ----------------------------------------------------------- <br /> --------------------------------------------- ------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY p } <br /> APPLICATION ACCEPTED BY --- - ---- ----- ------------------------------------------- DATE --..9" 3------------------- <br /> BLIILDING PERMIT ISSUED t{f DATE -------------------- <br /> ---- ---------------- <br /> ADDITIONAL COMMENTS ----------------------- - - -+- �W__ <br /> - <br /> --------------------------------------------------------------------- ------------------------------------------------- ---------------- ---------------- ----- - --- - - -- ----------Y---�j <br /> -------------------------------- ------ -------- --- <br /> - <br /> - ----- ------ - <br /> ---------- ------- - -------- ---- - --------- - <br /> Final Inspection b Date __.-___ --___-_ . <br /> P y <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5My��� <br />