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.,"'%.46 %r-��. APPLICATION FOR SANITATION PERMIT <br /> ... ..... <br /> (Complete in Triplicate) <br /> Permit No. �. d <br /> ......__..................................•--- <br /> ... This Permit Expires 1 Year From Date Issued Hate issued . /.. :�� <br /> Application Is hereby made to the San Joaquin Local Health Distrlci for a permit to construct and Install the work herein <br /> described. This application Is made in compliance with Founty Ordl ante N . 549 and existing Rules and Regulations: <br />` <br /> JOB ADDRESS/) ON ....... .. - ..........CENSUS TRACT .......................... <br /> Owner's Name .. ----•-. . --... . . .�. .. ..... ........... Phone <br /> <kddress �� ..... w. . .-- .....City ---------1­1 ................. <br />` Contractor's Name � � .. License .7_-� �-- Phone 4.............................. <br /> S_ (� - <br /> ...- .:.................... <br /> !nstai€ation will serve:3� Residence 'Apartment House Commercial❑Trailer Court f] <br /> Motel ❑Other--------------.............................. <br /> , <br /> i <br /> Number of living unit$:... .... Number of �j ooms .N.._.Garbage Grinder ............ Lot Size .................. <br /> Water Supply: Public System and name __4..._4'1......j42&Z .1f..........._..........................................PNvmte ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt(3 Clay ❑ Peat❑ Sandy Loom 0 Clay Loam ❑ ' <br /> Hardpan❑ Adob*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: INo septic tank or seepage pit permitted if public sewer is available within 300 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK" ............. Liquid Depth ...... <br /> �el............. <br /> Capacity ;� !�. .... Typ <br /> �• f?. AZQ.a).—Material ..... No. Compartments ....d`........... <br /> Distance 'to 'nearest. Well )1/J-,tJ.F..........Foundation .1.6.x._.___, Prop. Line_ <br /> TEACHING LINE '` No. of Lines ....c:2............... Length of each Ilne. -t`��.. Tota) Length ........ <br /> 'D' Box ..../..... Type Filter Material Depth filter Material ............................. <br /> Distance to nearest, Well ...... . .A.tiLIR... Foundation .... ........ Property line ....5 ................ <br /> r <br /> SEEPAGE PIT Depth ....�� ...... Diameter ..3:3......... Number ..........c ............. Rock Filled Yes �' No ] <br /> / n.. eve <br /> f. <br /> Water Table Depth ........IZA............................Rock Size . —n.. ....... <br /> lap <br /> Distance to nearest: Well ..... `�Qf <br /> .....------Foundation Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit ........ Date ..................................) <br /> SepticTank (Specify Requirements) ...........................4............. .....-----..........:......................................................._................ <br /> Disposal Field (Specify Requirements) ........................................................................................................-- <br /> ... ...........................•----------...-------------------------------•-- --............... <br /> ...........---•---•---............-..-.................. <br /> •................. <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 performance of the work for which this permit is issued, I shall not employ any person In such manner <br /> as to beco su lett to"rkmcln's Compensation laws of California." 4 <br /> :gnat' . .. . .---- .... ...... -1.- --•---- •--....----. Owner <br /> By ..................................... ����. /. . . . Title _..._.._.... ....-... { <br /> (if other thu owner[ <br /> irOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED .............................................................. DATE �'./.�:.:7.�...:..:.._........... <br /> BUILDING PERMIT ISSUED ......_._DATE.:......................................... <br /> ADDITIONALCOMMENTS ......................................................... --•-•-•-- ...........................................................................-............ <br /> .. <br /> -------- ----------------------......................................._.-------- - ....._...-----••........-.......--.... ..---.........---------•-----•--------------------. <br /> ........ ........ _ <br /> Final Inspection by: .................. ............Date .. ....:� ..' --- --------- <br /> M 13 2h 1-66 Rev. 5m <br /> SAN JOAQUIN LOCA! HEALTH DISTRICT- $/71; 3M <br />