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FOR OFFICE USE: <br /> --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT <br /> -------------------------------------------------------- a (Complete in Triplicate) Permit No,;7 <br />-- -------------------------------------------•------------- - This Permit Expires IDate Issued <br /> 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 Cqun tY Ordinance N9. 549 and existing Rules and Regulations: <br /> JOB ADDRESSAOC T N <br /> -4 TRACT <br /> Owner's Name EZ, W---1:Z ----------- <br /> ------- - ----------------- --------------------------- Phone ------------- <br /> Address ------ ----------------------- <br /> ..... ........ <br /> dD <br /> - -- - - ---- ------- -------- <br /> -------------------------------------------- --------- <br /> Contractor's Name City <br /> ------- ----- # -12'e,34F?7 Phone ------------ <br /> Installation will serve: —Residence- -Apartment-1 -------------- <br /> House.'�-C-ommercial--E]Trailet-Court iFj <br /> Motel [-]Other <br /> -------------------- ................ <br /> Number of living units:_- ----- Number of bedrooms f--_--Garbage Grinder ------------ Lot Size <br /> Water Supply, Public System and name_----- ­­ -z , , 1 0 A-- ------------------------------------- ...... <br /> -------------------------------- .... Private <br /> Character of soil to a depth of 3 feet:; Sand [] Silt F16Y—El Peat El Sandy Loom lay-L-o-a-m.E] <br /> Hardpan El 1 Adob6 E] 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 ..i <br /> (No septic tank or seepage pit perniitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f I r Size-*-------------- --------------------------------- Liquid Depth ----------------------­-- <br /> Capacity -------------------- Type ---------------------f Material--- -------- ------- No. Compartments ----------------- <br /> Distance to nearest. Well I -" .-­ <br /> - -- ------------- Foundation ---------------------- Prop. Line ------------I--------- <br /> LEACHING LINE No. of Lines-- ------------------------ Length of each lin'e---------------------- ----- Total Length ------------------------ <br /> 'D' Box <br /> ; --- Type Filter Material -------------------Depth Filter Material <br /> Distance to <br /> Pth nearest: Well ------------ ------ Foundation ------------------------ Property Line- --------- --­----­--- <br /> SEEPAGE PIT De --- ------ <br /> ----------- Diameter ---------------. Number ---------------------------- Rock Filled Yes No .c] <br /> Water Table Depth --------------------------------------- -------Rock Size ------ <br /> Distance to nearest: Well ------------------- ---------------- ---Foundation ------------- <br /> ------- Prop. Line -------••--------_--- <br /> REPAIR/ <br /> Se <br /> (Prev. Sanitation Permit# -------- -------------- <br /> -------------------- Date <br /> Septic Tank (Specify Requirements) ------------------------------ <br /> C' <br /> ----------------------- <br /> Disposal <br /> --- ------------------------Disposal Field (Specify Requirement) -,n-�- "Z- <br /> --- ------ - ------------------ <br /> ------------- <br /> ----------------------------- ------- ------------------- - ------------(----------------------------------------------------------------------------------------------------I------------ ------------ <br /> Draw existing and required addition--o-n--reverse-side)----------------------------------------------------------- <br /> ------------------ <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son 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 rformance of the work for which this permit is issued, I shall n employ any person n such <br /> as to become subi . to orkman's Com atio laws of California." *t manner <br /> Signed --------- <br /> --------- ---- --- - --- --- --- -- - -------- - --------------------------- Owner <br /> "o <br /> Comp <br /> By ----- ------- --------- --- <br /> i h ---- ---------------------- --- ---- ------ ------ -- --------------- Title ----------- <br /> - <br /> f other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION �;;jk� <br /> APPLICA`TION ACCEPTED BY <br /> BUILDING PERMIT ISSUED ---- ---- Z2, - ---------------- <br /> ---------------------------------- ------------- DATE-_-------------------------------------------------------------------------------------DATE 1K <br /> ADDITIONAL COMMENTS ------- --------------- <br /> ----------------- ---------------------I-------------- ------ --------------------------------------------------------------------------------------------------------------------------- <br /> - ------- ----- ---------------------------------------- -------- <br /> ------------------------------------------ <br /> Final Inspection b ------ - - ---------------- <br /> --- <br /> -------------�X--a------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --- - - <br /> -------------------- <br /> ----------- <br /> --------------Date ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M, <br />