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FOR OFFICE USE: * r <br /> r eLY <br /> APPLICATION FOR SANITATION PERMIT / <br /> - ----- -- <br /> (Complete in Triplicate) Permit No: _74:1- <br /> --------- <br /> __ -_�_c__-- __-- <br /> --------- •------------- <br /> Date Issued __,6_4�70 <br /> ------------- Thii Permit Expires 1 Year From 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 /> JOB ADQRESS/LOCAJION . y3 ----_--�J�_, ------------ ------------- CENSUS TRACT -------------------------- <br /> - -- --------- --------- <br /> Owner's Name ----------- _ <br /> Address _ ------------------------------------ <br /> Contractor's Name , ---• r-- -------------------License # ��r-/-�.� - Phone _7__---------�� /1i/ <br /> Installation will serve: ResidenceApartmAt Douse°❑ Commercial❑Trailer Court 0 <br /> S"- 4 <br /> Motel El Other' ------------------_ <br /> Number of living units:-_-_-!_-_-__ Number of`bedrooms _____Garbage Grinder------------- Lot Size���____________ _.__._________________rr I ____. <br /> - <br /> Water Supply: Public System and name ��--------'-----�------1------------------------------------- ` ------------------ -------------PrivateK <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ,C] Clay loam El <br /> Hardpan❑ AdobeFill Material ------------ If yes,type...--_-__-__'______________ <br /> f � <br /> (Plot plan, showing size of lot, location`of'system in relation to wells, buildings, etc. must be placed on reverse side.) r. <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted rif public sewer is available within 200 feet) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK; ] SiTe____________------------------------------------ Liquid Depth -------------..-.---------- <br /> Capacity ------------ Type -------------------= Material---------------------- No. Compartments _ - <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------------_.--_. <br /> LEACHING LINE [ ) No. of Lines __- ________________ Length of each line---------------------------- Total Length --------------------- ------ <br /> 'D' Box -------------I'Type Filter Material ____________________Depth Filter Material -------------------- <br /> Distance to nearest: Well ________________________ Foundation ------------------------ Property Line .-.--_..__._-__.__._-_._ <br /> SEEPAGE PIT [ ] Depth -------------------- -Diameter _--_-____-..__-_ Number ---------------------------- Rack Filled Yes ❑ No 0 <br /> ki <br /> Water Table Depth I <br /> ------------------------------------------------Rock Size '",-=---- •--------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation _ .. '"```---- Prop. Line --..-,----______ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------__-___`-__-___----_) <br /> Septic Tank (Specify Requirements) -------------------- ---------------------------------------•- - - ---------_- ------ <br /> Disposal Field (Specify Requirements) -- - --- � --- -- ------ ----' <br /> --------------- -­- • ---------------------- -- - ------ - --- --------------------------------• ----------------------------------------------- <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 performanc f the work for which this permit is issued, i shall not employ any person in such manner <br /> as to be me s b(ea to rk s Com�pef sat' laws of California." <br /> Signed 11 __ ----------- Owner <br /> By ------------------------------- ------ ----- - Title ------------------------------- <br /> (lf other than ow, er) <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- -------------- --------------------------------------------------------------------- DATE ------6--9-30--------------------- <br /> BUILDING PERMIT ISSUED --- ---------------DATE ------------------------------------------ <br /> ADDITIONALCOMMENTS —-----------------------------------t---------------------------------_­--------------------------- <br /> ----------=------------------------------------------------------ -------------------------------------------------------------------------------------------------- <br /> -------------- ---------- ------- <br /> ----------- <br /> ------ <br /> ----------=------------ --------- - - ---------------- - - ----------------- - <br /> -- <br /> ----- <br /> Finaf'Ins ection by -- D —------------------------- ---- ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />