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rUrK VFflCi~ USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ..................... . <br /> S-S--) i <br /> ' - - (Complete In Triplicate) Permit No. .,................... <br /> --------------•----•-•......•...•--•....._.._.._ ........ <br /> This Permit Expires I Year From Date Issued Date Issued .7-1 <br /> 7S <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. 5#9 and existing Rules and Regulations, <br /> JOB A,DDREss/Loc,nTloN .........., 6 ..._.... _7.//._.... _�............... ....... TRACT .......................... <br /> Owner's Name .:... �?_�-f�.�y�r�4/Yf Phone <br /> _..... ................... ............................... ................................. <br /> Address sib <br /> ..... city <br /> Contractor's Name ..__ _............ --------------------------License # ` . Phone <br /> Installation will serve: Residence JZ Apartment House 0 Commercial❑Trailer Court <br /> Motel ❑Other------ <br /> Number of living units:--- _____-- Number of bedrooms ._a-----Garbage Grinder ------------ Lot Size ......................... <br /> .......................................... <br /> Water Supply. Public System and name ....... -,.. __--• --------------------Private ❑ <br /> Character of soil to a depth of 3 feet�Sand❑,Silt❑ Clay- E3 -Peat❑ S_an_dy Loam Clay Loam ❑ <br /> - - - <br /> Hardpan ❑ Adobe Q Fill Material <br /> If yes,type...........I... �. <br /> (Plot plan, showing size of lot, location Nof-•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 f-] Size......... ...................................... Liquid Depth ......................... <br /> I <br /> Capacity ---------- -------- Type .. --------------- Material---------------------- No.. Compartments -.-................... <br /> Distance to nearest: Well ._-- - !......::-�........ -....Foundation -----__.3-. :. ---- Prop. Line ............-......... <br /> ` <br /> LEACHING LINE [ ) No. of Lines ---------------•-----_- Length, <br /> 4V 'of each line-____:....._____.__....._.-I Total Length .._._......._..........._... <br /> ' <br /> 'D' Bax ........_... Type Filter Material%t-------------------Depth Fitter Material' ............................................ <br /> f y I� .i <br /> Distance to nearest: Well ............... .....:. Foundation ...............-........#Property Line ........................ <br /> SEEPAGE PIT [ ) Depth -------------------- Diameter .......z...."- �Iuinber ---------------------- ..... Rock Filled Yes ❑ No 0 <br /> Water Table Depth ..................I........ .:...Rock Size --- 11 <br /> I / <br /> Distance to nearest: Well ----......................­....--_..:'FouT3datit�n �' ' <br /> - _ ._...._._.._..------ Prop. Line -•-------------------- <br /> REPAIVADDITION(Prev. Sanitation Permit# __________ ��-,_ .___ __Date,-� �•,--. -•- :_-'. -_--) <br /> Septic Tank l5�pecify�Requirements) - --- ,.t_. . . _r. ... ... - ....................... <br /> Disposal Field (Specify Requirements) .._. C .----- ----•-! 1� "----�.,�...lQ,,�_C4-...._.. <br /> -- - <br /> -•-•-----...-••---....... . <br /> _________________..__...._______._._�_________-__ ----------------------------------------------- ------------------------------------ .......... <br /> -._--_.._____---__-______- __-____i___. _-.,,__.__.-_«____________--_-___-_____-..__._____......__._ __-.._____._--.__----_.___-._.-...._.--...._. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done In accordance with San Joaquin <br /> County Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen. <br /> sed agents signature certifies the following: I <br /> "I certify that in the perfo mance of the work for which_this,permit is.Issued,,I shall not empto any person in such manner <br /> as to become subject to ark an's'.5ampensation. laws of California." '• <br /> Signed -----------441--- r ..�u4, - ........I........ ---------------------- Owner <br /> By <br /> -•------ Title ._......- <br /> - .(If other than owner)- - -- .... ._ <br /> '0�' FOR DEPARTMENT USE'ONLY r <br /> APPLICATION ACCEPTED BY --- - ©ATE <br /> BUILDING PERMIT ISSUED . ----.DATE ------ <br /> ADDITIONAL COMMENTS -------------------------------------- ------------------------------ <br /> ------------------------- --- <br /> ................----------- -----------............................. <br /> .. <br /> ------------- ......... -•-----• ------- --- - ------------------- ............--•------------------------ ...............__..__._._..... <br /> Final <br /> cion ----------------------------------------------------------- Date _..._..... � �y <br /> ------...--•---------------• . ..-- <br /> Final Inspection by: ...__. <br /> Elf 13 `�h 1-68 � 5i SAN .JOAQUIN LOCAL HEALTH DISTRICT 1 8/74 3M <br />