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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br />.......-•--•..................:..........ETM _ <br /> . Permit No. <br /> R.... (Complete in Triplicate) _ r.:.. _.. . ..._, <br />..........1.................•--.I.........•---- •---- <br /> Date Issued <br /> .-..-....... : This Permit Expires I Year From Date Issued <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. 649 and existing Rules and Regulations: <br /> JOB ADDRESS LOCATION '?T A? e_. ........ <br /> ..............CENSUS TRACT .--- ...... <br /> Owner's Name ------------- .....- - ...............Phone ....... <br /> o4C a�/aJ° 3 C� <br /> Address ......!41 --3-� ------------- ----- � .. ..:Ci -•- - - ---- - - •--•�.•��:.-,,// - ---..,.....----- <br /> Contractor's Name - ....... —.....................:........License•## Phone --_T_�� <br /> u <br /> Installation will serve: Residence p Apartment House Commercial OTraller Court <br /> Motel[3 Other---=•-----•---- ........... <br /> Number of living units:....../____ <br /> /. Number of bedrooms c�L,_Garbage Grinder --_­- <br /> rinder ----- Lot Size --------•- <br /> Water Supply: Public System and name ............. -- ........................................... vat! <br /> Character of soil to a depth of 3 feet: -Sand E] Silt 0 a Clay 0 Peat❑ Sandy Loam 0 Clay Loam p <br /> Hardpan 13 Adobe j ` Fill Material ............If yes,type............... ............ 4� <br /> F "i <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 it permitted If public seiver isavailable Lithin 2De feet,) --.�� <br /> PACKAGE TREATMENT ' [.J .SEPTIC TANK tom' Q ze... � !.- q pth <br /> Capacity/6Q�_........ Type%)les Materia} Oh.C,7o. Compartments �•� <br /> ..................... <br /> lance to nearest: Wel! , <br /> ...Foundation Pro Line t' <br /> - - - _ - p. ..........or.............. <br /> If <br /> LEACHING LINE [ No. of Lines.: .......• -- Length ofNMI* <br /> adh line..- a.4-- --.---... Total Lengthr._,/D__- ......_....... <br /> _ p t <br /> 'D' Sox .flr�... Type .Filter Material --.Depth Filter Material <br /> d-•-•........................... <br /> Distance to nearest: Well ----4'0 Foundation -_-- . ..._....__. Property Llne ^ ............ <br /> SEEPAGE PIT [ Depth --n .0----------- Diameter Number ........./................ Rock Filled Yes [)• 1�o C <br /> Water Table Depth .......... ..............................Rock Size ..1�,? .x ,fl...... <br /> Distance to nearest: Well ......1!_.8:...............Foundation .. - ..... Prop. Line . .......... <br /> REPAIR/ADDITION(Prey. Sanitation Permit{# :_ } <br /> --• -_. Date .--••--•-- ---• ---.--- ------ <br /> Septic Tank (Specify Requirements[ ----.......---------_.............. ....••••:---•-••-•-----•------•-•----•••••--..._•.•----................_._,..--••-------•-•--•----•--•... i <br /> Disposal Field (Specify Requirements) ----- ----------------------------•---.............................................................. - =--------............:................ <br /> --------------------------------------------- ----- --------•-- -----------•............................................................................._...__..............._••.... <br /> ----------------------------------------------------------- ......................................... <br /> • I <br /> (Draw existing and required addition on reveese side) <br /> I hereby certify that I have prepared this application•and that•the,work will .be done in accordance with San Joaquin J <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Dlshict. Home owner or Been- <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 become subject to Workman's Compensation laws of California." <br /> 9 <br /> Si ned --------------------- - Owner <br /> By --------------------------- ....................... Title ---- <br /> (If of than owner) <br /> 1 <br /> 4 e <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED .BY.--• .. DATE ....__�,. :............. ............... <br /> BUILDING PERMIT ISSUED ................. ....---- ...- .- -- - - ..---DATE _-.--_-_ <br /> ADDITIONAL COMMENTS .......................•-- ................................... <br /> I _- al -: �. <br /> -- ---------------------------•- ..........- ---- - -----------------_--_ - <br /> •------ <br /> r _.. . _. <br /> ---•------- --•-------- ---- --------•--•- ------ . �� <br /> _ .-.•.. . ..................................... Date "7 ............ <br /> . _Final Inspection by: <br /> EH 13 24 1-68 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />