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FOR OFFICE USE: �. APPLICATION FOR SANITATION PERMIT <br /> -...---- --------------- ............ <br /> ` a (Complete in Triplicate) Permit No. ... <br /> ........................................ ... .. ... ..:.... This Permit Expires } Year From Date Issued Date Issued ... <br /> .._._.I....... .................... :.~fy <br /> _... ............. ,r-. <br /> Application is hereby made to the Sari Joaquin Local Health"District for a permit to construct and int it the work herein <br /> C described. This application is made in compliance ith County Ord' ante No. 549 and existing Rules and Regulations: <br /> k <br /> k <br /> JOB ADDRESS/LOCATION ' _._, ... �cf ...,�/ ..c............._..._...V._....._.,....,CENSUS TRACT _....._..._..._..._.... <br /> Owner's Nome ..... .---- t� `r�E '_....... <br /> . ............•.......•.........................- •--......:.........Phone..................................... <br /> Address ....afee7 .................................................. City /��+��........ .............................................. <br /> Contractor's Name ------ QAIPr/..................................License # Phonaj5;4A.i..Z.e .,�.. .... <br /> Installation will serve: ResidencejXApartment House❑ Commercial.❑Trailer Court ❑ }f <br /> Motel ❑Other ............................................ F <br /> Number of living units:...,l__._ Number of bedrooms .......Garbage Grinder AV_- Lot Size : ......... <br /> Water Supply: Public System and name ............... .. ..Private m <br /> l Character of soil to a depth of 3 feet: Sand 0 . Silt❑ Clay ❑ Peat} Sandy Loom'_fl Clay Loam ❑ <br /> i <br /> Hardpan ❑ Adobe°❑ Fill Material ............ If yes,types............ ............. <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse .side.) <br /> i <br /> i NEW INSTALLATION: {No septic tank or seepage pit permitted if Public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK ) ize .�.X . Li uid De th <br /> i [ a _ .•. . ... s .................... q P ................ <br /> Capacity/ V1._...._ Typ _. _ ._._.. Material".W. o...... No. Compartments ...................... <br /> 2 � <br /> � r - <br /> Distance to nearest: Well Foundation .............. Prop. Line .-.7=7:........ %P <br /> �------ Length of each line..1�r,�--..- ................ Total Length d <br /> LEACHING LINE 14 No. of Lines ...-• _ _ g g ,�-�p................ <br /> 'D' Bo/eto <br /> &✓�._ Type Filter Material 1 64-0_.Depth Filter Material le ... <br /> Distannearest: Well .... .e�. ..... Foundation _ � __..__..__ Property line <br /> ••• = <br /> SEEPAGE PIT O Depth .................... Diameter ................ Number ----------­­--- Rock Filled Yes ❑ No 00— <br /> ` Depth T - - to Table ------•----•---•---•............................Rock Size- .. , <br /> '1 <br /> Distance to nearest: Well ........................................Foundation __..._.._ ......... Prop. Line -_----.__.....__----- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................. Date ..---.------- --------------- <br /> SepticTank (Specify Requirements) ---------------------------•---••-•--••---••---•..................................--.................................... <br /> Disposal, Field (Specify Requirements) _"`t".T"-9.. --------- <br /> -- ------ <br /> -`' VC, .; <br /> ------------------ ---------------=------- ------------• --------------•-----------•------------------------- -----------------------------•----••----•-----••---.............----._......:.. .......---. <br /> ' ;1(Draw existing and required addition on reverse side) <br /> I hereby certifi-that I have prepared this application and that the work will be done in accordance with San-Joaquin <br /> County Ordinances;State-Laws,-arid 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 ' <br /> -------------------- --------•-::-•-•- -- -- -•--------...-.................. Owner <br /> ills <br /> P(l er than owner} <br /> t FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED BY r::..... ':"DATE 7�1< ._.. ._. <br /> _....-•--•---...•-- .....-----•-------•- <br /> ,: <br /> BU LDING PERMIT ISSUED -------------'-------------- -- -...............---.....--------:...._.....:......:--••--•--•-............DATE ......... ................................. <br /> ADDITIONAL COMMENTS { .... =.... ...............•_._._...._......_I._..•_........_ <br /> -•-•-•• . ...... ............. . .._........_..................-----.....--------...•.......•............._._-.......••--•-••--- ----. <br /> .................................. ........ <br /> FinalInspection by: ... ....................................................................................:......Date ..��..'I.......... <br /> if Aq <br /> SAN JOAQUIN -LOCAL HEALTH DISTRICT <br /> k F H 13 24 1 Wk Rov'SM 7/72 3 M E' <br />