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,14 FOR OFFI SE: il <br /> APPLICATION FOR-SANITATION PERMIT <br /> T <br /> ..........I....--- ............•---. 1'errnit No. .7.7:.� 73 <br /> �.. <br /> (Complete in Triplicate) . - <br /> ...._...... <br /> ....... ... ..... This Permit Expires 1 Year from Date Issued date issued ._._'.7..��.. <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 /> JOB ADDRESS/LOCATION Ak��...........................CENSUS TRACT ...,...-. ............. <br /> L/° � /� cc e Sa3-� '�gta <br /> OwnersName ......_....-.-...�.�.��?.........................................�------.....----,........._.._..:.....................Phone ---•-•-...................---......- <br /> // <br /> Address --- -------------•-----�---._'�r...._S�.G.'..7*4_GAhr-cl..... City _..1Vb!�7!7CrA..............._..._............................. <br /> Contractor's Name ----------------------License # . 5`��" ----- Phone .' '--e `� r <br /> Installation will serve: Residence(W Apartment House[] Commercial OTrciler Court 0 <br /> >. Motel [I Other --------------- .......... .................. <br /> Number of living units:_..,...... Number of bedrooms .. 7......Garbage Grinder ------ Lot Size ------------------------------------------•- <br /> Water Supply: Public System and name ................... •-•-----------------• ...............-----------------------------------------------......Private <br /> Character of soil to a depth of 3 feet: Sand's Slit.0 Clay 0 Peat Q Sandy Loam ❑ Clay Loam 0 <br /> Hardpan❑ Adobe C] 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 /> PACKAGE TREATMENT # ] SEPTIC TANK{ ] Size........................................_----- Liquid Depth .__ ...................... 0 <br /> Capacity ---/A5�q..... Type RA�-.4 . r Material---- ----- No. Compartments !!K S <br /> F Distance to nearest: Well ..... "------------­--------Foundation ------ -----.Prop. Line -------_---- <br /> LEACHING <br /> -_----LEACHING LINE [ ] No. of Lines -------------- Length of each line....................... Total Length ......................'D' Box ---..------- Type Filter Material ....................Depot Filter Material ........................................... <br /> F47e-' 1315 Distance to nearest: Well ........................ Foundation ................... Property Line .....`. <br /> ............ <br /> SEEPAGE PIT ] ) Depth .............•...... Diantetv ��rNumber ................:........... Rock Filled Yes M No O <br /> Water Table Depth ..............t r0. ------------.Rock Size --• ----_------------- ------- A: <br /> Distance to nearest: Well ----- ----------------------------------Foundation --_-------_----- Prop. Line ....................... <br /> REPAIR/ADDITION Wrev. Sanitation Permit# .......:......................•--------. - Date ..............--....--------------1 Q� <br /> SepticTank (Specify Requirements) .----------_----- ----------•--•---........_.......••--------••..............._....----------.........._...........-=---------............. <br /> DisposalField (Specify Requireme ts) -------_---- --••---- -------------•-_-------------------------- ................................_..--•-••--•---------- -- <br /> -------------•----------------------------------- ------- -------------- -------------------------------•----------- --- --•-------••---- ----------.._._.............................................. <br /> _.c <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 to Workman's Compensation laws of California." <br /> 4 Signedft. 7 I' . '?fit Owner <br /> By :. �;..��.-..._ Title _.... . <br /> (if other ner) <br /> i <br /> FQJI DEPARTMENT 'USE ONLY <br /> APPLICATION ACCEPTED BY - --- ---- - ---------•---- DATE ... 7-7----- <br /> BUILDING PERMIT ISSUED .......... ........ .........................DATE --....... ................................. <br /> ADDITIONAL COMMENTS --------__I...................•--• -•--•---•-•-------------- -............. ........... ...... ....... ••---------_..-------=--•---.....---•----------- <br /> ------------------------------------- <br /> f --------•--------------•--- _--------. ._..._.. ..... . ------... _ r--....-._.. --- ......... <br /> ---- ---------. ... . . �{� <br /> final Inspection by: -------- -- ..:--- --------.Date __..: .�T.- <br /> 3 24 1--d 5 SAN OAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />