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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----- -- ---------------------------------- ----- Permit No. -------- <br /> ------------------ (Complete in Triplicate} � -� <br /> ------------------- ----- ,/ 3 <br /> ___ ---------- This Permit Expires 1 Year From Date issued Dame Issued _'�`-: .-.------ <br /> ----------------------------------------- <br /> . __. <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> .CENSUS TRA T ------------ <br /> Owner's <br /> _.y. <br /> JOB ADDRESS/LOCATION ../.._JrT•'y� 1)LZt3 - p <br /> Owner's Name -------------------- Phone <br /> Address ---------------------- ------------------------------ ------- ---. City `� /�T------------_------------------------ ---------------------- <br /> k 11 <br /> Name �... -- - J•-------=--------License #!_1_- 0 - Phone - -T'..:".* 7� <br /> Installation will serve: ResidencekAportment House❑ Commercial :❑Trailer Court ;❑ <br /> Motel ❑ Other -------------- ----------------------------- <br /> Number of living units------- --- Number of bedrooms ____ ----Garbage Grinder -W.0- Lot Size --_ - ----- <br /> Water Supply: Public System and name ------------------------------------ -------------------------------------------------------------------------Private ❑ 1 <br /> i <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam.❑ <br /> Hardpan E] Adobe*Fill Material - If yes,type --- ---------------------- (N%.� <br /> - ll <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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK'[ j Size------------------------------------------- ---- Liquid Depth --------------------------- <br /> Capacity <br /> -:--------------- ----- <br /> Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ------_-.--------_- I <br /> Distance to nearest: Well ______.__------------------------Foundation _.-------------------- Prop. Line ___-_--____:_-_-___ <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length -----------------.---- ---- <br /> 'D' Box ------------ Type Filter Material -_..__.___________Depth Filter Material -------------------------------------------- <br /> Distance to nearest: Well ___________________ Foundation ------------------------ Property Line -.----_-_-._-_----.---_- <br /> SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number _-----.-_ ----------------- Rock Filled Yes ❑ No i❑ <br /> Water Table Depth --------------------------------------- -------hock Size -------------------------------- <br /> Distance to nearest: Well -------------------•----------------.---Foundation -------------------- Prop. Line ----------------...--- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- -- <br /> --------------------------- Date ----------------------------------�` <br /> - - -, <br /> Septic Tank (Specify Requirements) ------ ------------- ---------------------- - --------- ---------------------- <br /> Disposal Field (Specify Requirements} ._'T��-____ ____ f _ -C- -- --"f-�'�,----C -- ti <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 /> 4 "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 becom -ubiect to W kman's Compensation laws of California." <br /> Signed3 _ Owner <br /> 411--1 -7---- -------------------------------------------------------------- <br /> BY ......---------------- ---------------- ------------------------------- Title ---- - -- - --- ------ ----------- - ----------------------- <br /> (lf other than owner) <br /> 28 DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- - <br /> -- -- -- - -------------------------- ---- ---------------------. DATE ---- --�- ----��� <br /> BUILDINGPERMIT ISSUED -------- -- - -- - ----- - -------- -------------------------------- ----=--------------DATE ------- ----------------------------------- <br /> -------------------------------------------------------- <br /> .A..D...Df!!! �ONA_LCOMMENT . .___ ___ _ __ _________.-________.._.._______._ <br /> __� �_.._.___________________._____.f,______________ <br /> ___ _________________________________________________________________________ <br /> _ --------------------------------------- _ -.- .___ _ ----_________-___.-_.---------_-_.------------------------------------------------------------------------------------------ <br /> Final Inspection b -- -------------------- ,� _ <br /> p Y ---------Date <br /> 5� JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 5M <br />