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FOR OFFICE USE: APPLICATION»FOR SANITATION PERMIT <br /> . 7 ---------- 7(_ / <br /> � 2f � ---. (Complete in Triplicate} Permit No. -_.-__.__.. —�._�_ <br /> This Permit Expires 1 Year From Date Issued Date Issued _0171. <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. 349 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ---/_ z ------------------------- <br /> -------- --- CENSUS TRACT -------------------------- <br /> Owner's <br /> ---- --- ---------------- <br /> Owner's Name ....... ------------- -------------------------------- ------------- -------Phone -------------- ------ -------------- <br /> Address ------ C _- .------- <br /> Contractor's Name ----------- 1�,7 .-_ Phone -- -- '/----- <br /> -----------------------------License # -- -- --- yL <br /> Installation will serve: Residence 'Apartment House[] Commercial ❑Trailer Court i❑ <br /> Motel ❑Other--------------------------------------------- <br /> / r � <br /> Number of living units:.--. ---- Number of bedrooms ,cA-_--Garbage Grinder &Q--- Lot Size _--_------------- <br /> Water Supply. Public System and name ----------------------------------------------------------__- -----------------------------------------------.Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> �� l <br /> PACKAGE TREATMENT I ] SEPTIC TANKM Size-r�j-._.�`.,f_'�J�------------------ Liquid Depth _- ------------- - <br /> Capacity/900 Type - _-__ Material_6&Y46W­No. Compartments ZV?---------------- <br /> / <br /> Distance to nearest: Well ------------------------------ ----- -- ------------- Prop. Line _$`�--_-_._. . <br /> LEACHING LINE No. of Lines ------ --------- r r . <br /> --_-__-- Length of each line----- Total Length --y®--.---_------------ <br /> /r <br /> 'D' Box 41-0----- Type Filter Material �l ------Depth Filter Material ,�f------------------------------- <br /> ------ <br /> Distance to nearest: Well ------------------------ Foundation -------_---_-_ Property line <br /> -------- Pro -- ------------------- <br /> SEEPAGE PIT ' Depth _Z51S_~------ Diameter Numbe -----f------------------- Rock Filled Yes,; No 0 <br /> � r <br /> Water Table Depth --------------------------- Rock Size f f <br /> Distance to nearest: Well :�------------------------Foundation /G.,-- --__ -- Prop. Line -137--_-_-_.._-.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> SepticTank (Specify Requirements) -------------------- -- --------------------------------------------------------- ----------------,,.--------------------------- <br /> DisposalField (Specify Requirements) --------------------------•------------------------------------------------------------------------------------------•---•----------- <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 become subject t Work a 's mpensation laws of California." <br /> Signed -------------------- ---------- -- - - -- -- --------------------------------------------- Owner <br /> By -------------------- -- ------------ -- -- - - ----------------------------------------------. <br /> Title --------- ----------------- ------- <br /> - --------------------------------- <br /> [I othLe t wner <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ _--_-_ DATE G _-7�_______________ <br /> - -- --------------------------- <br /> BUILDING PERMIT ISSUED -------------V------- -------DATE ---------------------------------- <br /> ADDITI AL COMM ------------------------------------------------------ <br /> &X <br /> ----------------------------------- ---------------- <br /> Vr� <br /> !�-�I -- _ 1 - ------ --------- --------------------------------------------------------------- :. <br /> --------- -- - ---- - - 1 <br /> --------------------------------- ------ ------- ------------------- - --- !_ <br /> - --------- - ------------ <br /> Final Inspection by: -3. e <br /> b 7/----- ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />