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FOR OFFICE USE: APPLICATION FOR SANITATION PE <br /> RMIT <br /> ................................ <br /> (complete ln,Triplicate) <br /> Permit No. d <br /> ......................................................:. This Permit Expires I# Your From Date Issued <br /> 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 /> q <br /> JOB ADDRESS LOCATt N �.!-.__-- -�---•• � ( �id.Gf.� <br /> .. _ ........... ...-•-•--•-------•....•••------....CENSUS TRACT ... ..................... <br /> Owner's Name - - • • •--. .....--- ---. ...... -- -----------------•---•------......_...-----=-. .......... -__Phone . 1 - � <br /> Address --.-..--� A.-,4-r. 'SGon� <br /> ..............•-------•--•---•-- --. City ................................. ------•-- <br /> Contractor's.Name . .License# . .......... Phone <br /> -installation will serve: Residence-M'Apartment House Commercial QTrailer Court ] <br /> Motel ❑Other..--•---•.. .... ......... :......:..�_ <br /> /---Number of living units:-... Number of bedrooms ___ -..._Garbage Grinder ............ Lot Size ... <br /> Water Supply: Public System and name .. ....Private❑ <br /> .._._ ._..-----•......_____......__..._.....__-•-----•-•--------------- <br /> Character of soil to a depth of 3 feet: Sand[] Silt(] Clay [J_ Peat p Sandy Loam Clay Loam <br /> Hardpan 0 Adobe 0 Fill Material ...__._. ... If yes,type <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placedjon reverse side.) s <br /> NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer is available withirtl'8 feet,} <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I } Size..........................•...................... Liquid Depth .......................... <br /> r Capacity ---------------_-- Type _-....__ Material.................__ 'Nd. Compartments <br /> —T4vk Distance to nearest: Well .............:......................foundation ..-..__-....._._...... Prop. Line ____ ................. <br /> LEACHING LINE [ J No. of Lines :. :................... Length of each line ___---- -__- Total Length ............................ 3 <br /> D' Box ...l------ Type Filter Material . . . epth Filter Material ........../-.3.'..�.---•-------.�_._:._._ <br /> r` i <br /> Distance to nearest: Well _�?p lJ.._. �.__--_ Foundation _./ ...7 ...... Property Line _-... '......7.4., <br /> SEEPAGE PIT [ } Depth -------------------- Diameter -----3...........Number ..._.....-.....-............ Rock Filled Yes 0 No tL] <br /> Water Table Depth ................................................Rock Size -------......----..........----- <br /> Distance to nearest: Well ........................................ _-_- Prop. Line ' <br /> foundation .......... <br /> REPAIR/ADDITIONSanitation Permit# pate <br /> (Prev.1 .................•--------•-••-...•-- ---................................ <br /> ) <br /> Septic Tank (Specify Requirements) -•...... ----------............s••-•--r-c.......... ....•-------...•-- • ................. - <br /> - - <br /> Disposal Field (Specify Requirements) : l _•rJ ----• ----------------------- <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 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 sign tura certifies the following: <br /> "1 certify th t i the perform c of the work for which this permit Is Issued, I shall not employ any person In such manner <br /> as to beco 's C ensation laws of ColifUOwner <br /> 3 <br /> Signed -. t-ft"'017 BY - I <br /> {tf other than owner} <br /> F DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .-- -- ---- --• •-• _-----•.DATE ..J.__ = =•-------- <br /> BUILDING PERMIT ISSUED ...------- -=------- --•---• - .............. <br /> ---- -- - DATE .............................. ......... <br /> ADDITIONAL COMMENTS -. .................................•...---..:--------..._._..-.-.--_�'-......---:-...----•-..... ... ......................................... <br /> ----------------- -- <br /> -----------------•••----- -..-...-.-.....-..-...-----...--..--•-•-----.- <br /> ----------------- ---- -- <br /> Final Inspection by: . ---.--------••----•------------- Date/ -- = . . .. <br /> EH <br /> 13 2h 1-68 Rev. 5mSAN JOAQUIN LOCAL HEALTH, DISTRICT 8/74 3M <br /> I <br />