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FOR OFFICE USE ` <br /> y APPLICATION FOR SANITATION PERMIT <br /> -------- -- --- --------------------------- <br /> ' '' Permit No: -----�-'S"$..j <br /> (Complete in Triplicate) <br /> - ------------------------------------------------------ <br /> --------------------------------- ---------- <br /> Date Issued <br /> This 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 ADDRESS/LOCA N ._._ ,(/j ---------------- <br /> ----------------- <br /> Owner's <br /> _ _.__ <br /> r -- ---- �- , � ---CENSUS TRACT -------------------------- <br /> r-r� <br /> Owner's Name t EI .: r --- --------- <br /> pf, j---- <br /> Phone ------------------------------------ <br /> AddreAddress <br /> ss - ---------- - ------------ -- ------ --- --: - - CitY ------------------------------------------- <br /> ------------ <br /> '. - License # ZPhone �GContractor's Name ---------, - — -------�--- � ' -- <br /> Installation will serve: Commlercial <br /> l <br /> I Motel F1 Other ;= <br /> ,, t ! <br /> Q <br /> Number of living units:-.[--/----_ Number of Eiedrooms ___.�_____Garbage{Grinder-��=___--Lot Size=�__�� <br /> ff �� ----- -------------•-------- <br /> Water Supply: Public System and name _ �c �cJC -----------------------------------------'_-_.-Private ❑ <br /> Character of soil to a depth"of 3 feet: Sand'❑ Silt 0 Clay Peat ❑ Sandy Loam ❑ Clay,Loam ❑ <br /> A ` <br /> Hardpan Adobe Fill Material _ !V <br /> .a_ ,...._ P ❑ _ ��- If yes, type ---- --"- --- ----- --- --- <br /> (Plot plan, showing size of lot, location of system in relation;to wells buildings,Fetc..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 TANK [ ] SizeA-------------------------------- Liquid Depth -------------------------- <br /> N)Capacity -------------------- Type --------------" Material---------------------- No. Compartments ---------------------- <br /> Distance to nearest: Well --------------- ---_-:------------Foundation ______________________ Prop. Line _"-___________________ <br /> i <br /> LEACHING LINE [ ] No, of Lines ------------------------ Length of"each line-------------.-------------- Total Length ._________..._______.____-- <br /> 'D' Box Type Filter Material {--- .._...._t------Depth Filter Material --------------------________________________ <br /> Distance to nearest: Well ________________�: Foundation _._"_-_.______________" Property Line -_______.----____---_-- <br /> SEEPAGE PIT [ ] Depth t____.______-_____ Diameter _ Number_:'`•. "_______________ Rock Filled Yes ❑ No i❑ <br /> --------------- <br /> Water {Table Depth -` ------Rock Size �`- -=--------------- i <br /> ---------------------------- -- -- -- -- - <br /> J i - ff <br /> Distance to nearest: Well ---------------------`------------------Foundation -------------- ---.: Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------- ---- --------- ----------- Date """__________ ____________________} <br /> Septic Tank (Specify Requirements) ------------------------------------ -- -------=- -------- ------------------------------ <br /> I Field (Specify Requirements] ----- ------ -------- ------------- --------------- <br /> = -- -------------------------- ----------------------------------------------- <br /> -------------------------------------------- ------------------------------------------------------=--------=--------------------------------=------------------------------------------------------------- <br /> {Draw existing and required;addition on reverse side) ,{ <br /> I hereby certify that I have prepared this application and th t!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. Horne owner or licen- <br /> sed agents signature certifies the following: f <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 Owner <br /> BY 1 = ;'51 itle ----------C& -�. <br /> ................... ---------- <br /> ( han owner] s <br /> r , FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE ----------------- <br /> BUILDING PERMIT ISSUED,"------ --------------------------------------------------- ---------------------------------------- DATE ---- --------------- ---------------------- <br /> AD7EONAL COMMENTS <br /> - -& -- =' <br /> = -- ----------------------------- - '� 5-'1�7- - `° - Z ---------------------------------------------------- <br /> -------=---------------------- ------------- - - <br /> _____ ------ <br /> _ -" <br /> -------------- -9 <br /> Final Inspection by: L ------------------------------------------- --------- ----------------------------.Date ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br /> d <br />