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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT -7 <br /> -------- ---------------------- (Complete in Triplicate) Permit No. - ----- (�- <br /> ---------=---------------- ------------------------------ <br /> This Permit Expires 1 Year From bate Issued Date Issued <br /> ------------------------------------------------------------------------------------------------------------------ <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 nd ex' ting Rules and Regulations: <br /> r� <br /> 106 ADDRESS/LOCATION .__T --------------- <br /> 5 -- <br /> --- -- = ----- --CENSUS TRACT <br /> Owner's �Nyama ?��.�� - r"rc. = -------------------------------------- Phone ------------------------------------ <br /> Address -/ ` ------ 2)�'1'C ��sx���l!_ City 7 <br /> Contractor's Name /. �,J { -FJ�3/�� <br /> L �� L�l�[� License # Phone <br /> Installation will serve: Residence p6Apartment House-[] Commercial ❑Trailer Court ;❑ 1 <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:-_f ----- Number of bedrooms __ � <br /> ____Garbage Grinder ------------ Lot Size ---------•-- <br /> -_--__________-___- <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 ❑ IeIe` <br /> Hardpan ❑ Adobe X 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 [ ] SEPTIC TANI Size __ _� 5�1�_ ---___ _ Liquid Depth __________________________ <br /> Q Material__ No. Compartments <br /> Capacity ,��-a-C?----- Type u"-�_� �-��'f -rv-•------ <br /> Distance to nearest: Well ------ _ __________________Foundation <br /> �_-______ Prop. Line __,�.___ .____ <br /> LEACHING LINE No. of Lines ______/______________ Length of each line----Y41�-�4. ----- Total Length __,M!_:0-___---------- <br /> 'D' Box -----/_-__ Type Filter MaterialJ.Depth Filter Material ___/__�______________________--:__._ <br /> Distance to nearest: Well __ __-___-__---_-Foundation�/4_______-_---_ Property Line �1_____________________ <br /> SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No C <br /> Water Table Depth ------------------------------------• ----------Ro <br /> ck Size -------------------------------- <br /> Distance <br /> - - ------------------------Distance to nearest: Well ----------------------------------------Foundation ------------------- Prop. Line ------------------__-- <br /> REPAIRfADDITION(Prev. Sanitation Permit# -----------------'----------- t------- Date -------------------------------] <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- --------------------------------------------------------- <br /> i „ <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- <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 per+Oer <br /> e work for which this permit is issued, I shall not employ any person in such manner <br /> as to beco e s blect,t mperLa tion laws of California." <br /> Signed - --- ---=-------- ---- ----- Owner <br /> BY ------------------------------ --- -= ------- Title <br /> (If other th <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> 'mss_- -_-`-- ---- -------_. DATE __- ° _ - --C2___________________ <br /> - -- ------------------ ------------- <br /> PERMITISSUED ------- ------------------------------------------------------------------------- ---- ------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------------------------------------------=--------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ <br /> _- --- ---- --------- ------- ---------------------- ---------- - ---------- ---- ---------------,Date- -- - -------- <br /> - - - - ` <br /> Final Inspection bY: ---- - - ----- - ------------- -------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />