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FOR OFFICE USE: - <br /> APPLICATION FOR SANITATION PERMIT <br /> {Complete In Triplicate) Permit No. .7y_-�/� <br /> """ " This Permit Expires i Year From Date Issued <br /> ...................... Date Issued <br /> Application is hereby made to the�San Joaquin Local Health District for a <br /> described. This application is made in compliance with County Ordinance No. 549 and exisermit to ting Rules and and Rework gulations:rein <br /> JOB ADDRESS/LOCATION .... 2. _ . _. <br /> I' Owner' fN._.:.. ..................... <br /> Owner's Name -- <br /> . ...... .................................. <br /> CENSUS TRA <br /> Address '� -­-----­------ <br /> ---•------ •---•----...-Phone ......... - <br /> e.. City <br /> . --- -- ..... •-- - <br /> Contractor' <br /> s Name ..- .................. . <br /> wiz �c,r -- -- ....License = <br /> Residence ©Apartment House❑ Commercial❑Tra€ler Court C] - <br /> Installation will serve: _ _ <br /> 1 Motel ❑Other ......... l .� <br /> Number of living units:_.-.. Number umber of bedrooms <br /> Water Supply: Public System an �.. <br /> - • <br /> Garbage Grinder ..--------v Lot Size ..._:....y-'°= - <br /> me d no ........... ....•-_--• -- • r <br /> Vl <br /> ... <br /> Character of soil to a depth of 3 feet: Sand p ......................._ Private <br /> [] Ga <br /> Cloy ❑ Peat�] Sandy loam 0 .,.Cla71% y Loam �] <br /> Hardpan L� Adobe.❑ Fill Material _.' : i 'Y <br /> (Plot plan, showing size of lot, location of. system in,relation to welts, buildings, etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seep a pit permitted if vblfe sewer is available within 200 fdetj <br /> PACKAGE TREATMENT SEPTIC,TANK- 1 <br /> i <br /> - --. ..----••--•----.._. Liquid Depth ._..�..... <br /> Capacity . _LSU------• Type ._...._. . ' <br /> Materia}.__ No._Comportments .. .. . <br /> Distance to nearest. Well " .............x <br /> S.P._ .(`.._.-•-•--._.Foundat€on .. -,(.lj-•`• Prop. line ..._�''............... f <br /> LEACHING LINE [ No. of Lines ....___.`_ .._-. Length of each line---.-------7- <br /> 5-!.""`YTotal Length .... S ' <br /> N <br /> • 'D' Box a Filter M ' <br /> ._...._�._.. Type Material S A.....--De_Depth Filter - --•--..... .---• i <br /> P Material S <br /> Distance to nearest: Well ........................ Foundation _4................. t <br /> SEEPAGE PIT t Property Line .._ .. <br /> i. De th ,� �•... Number .........p . . .... .-.---__-. Diameter �6 _ Rock Failed Yes. .......... <br /> Water Table Depth / o <br /> P :_...�Q:Q..---•-......._ ...Rock Size <br /> �• N N � m <br /> Distance to nearest: Well ....... �S?.:Q__.�.::._....�....:..Foundation ._.�_a.� � <br /> REPAIR/ADDITION(Prev. Sanitation Permit Prop. Line _. ,-------------- <br /> _, V] <br /> # Date A <br /> Septic Tank (Specify Requirements) ;...... ........... <br /> • --------------------- ...... -•--.......----......-......... <br /> Disposal Field {Specify Requirements} ••----•--•- - ` <br /> I ..........- -•.................I................... <br /> -- <br /> l4 <br /> ---------------­------------ <br /> ­---------I........................:.......•-•----•-- .................................................... •-------._....---...•--......_ <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 ti <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Ham& owner or i cert- <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 subiect to Workman's Compensation laws of California," <br /> Signed ••------ <br /> ... ••-•--..... <br /> Owner <br /> By •-•-- ...... ........................••--..._._.. ---1�� •-- -----.. <br /> 10 <br /> - Liff ._ y <br /> (I e other than owner) . <br /> FOR DEPARTMENT USE ONLY Y <br /> APPLICATION ACCEPTED BY ...._. _ <br /> BUILDING PERMIT ISSUED _:........ <br /> =- ` -_..._.._. ........:...... ---..._... --•..•.._...DATE ...�... ..... <br /> ADDITIONAL COMMENTS ................................. <br /> ......... ..••••-•--- <br /> _ ................................ ........,........_................. <br /> ...............................................:. <br /> Final inspection by ----•------- ------- ....._....---••-- ---------------------------- Y.... <br /> ............ <br /> {: •� <br /> .. /. <br /> .................................Dated..:1 <br /> ' SAN JOAQUIN -LOCAL HEALTH DISTRICT <br /> E. H. 13 24 1-'68 Rev. 5M <br />