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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------- - �-------------------- Permit No: ---- <br /> N 7 <br /> �I {Complete in Triplicate) <br /> ------__II____- This Permit Expires 1 Year From Date Issued flats Issued <br /> Application is hereby male 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 /> i `D q - <br /> JOB ADDRESS/1­01 TION --_-L _ ��--- ----J-f_-i-!_FF -LS------------------------ �-J <br /> J j / ____CENSUS TRACT <br /> Owner's Name l- P-`-----/--------- --------------------------------------------------1 1 Z//1C--------------------------------------------------- ---------Phone <br /> �j T ` Ci 3� y <br /> Address - -,. 713-a�)--Jl-----C5------�P12eehel—r C' --------- City ------------------------------------------ - <br /> __ <br /> --- SiContractor's Name ----- - 1z__,• �- -i2 �-_C =- ----------------------------License #r--- Phone <br /> _ ------------ <br /> Installation <br /> nstallation will serve: Residence]Apartm nt House^❑'Commercial :[-]Trailer Court i❑ <br /> Motel ❑ Other ------ <br /> Number of living units:---I-------._ Number of bedrooms -------t-,-Garbage Grinder ------------ LotSize , -.1- <br /> Water Supply; Public Systllm and name ------------._ <br /> ------------- •--------•-------- - ---------------•-------------- --- -- -----------------Private E7111 <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 /> l (Plot plan, showingsize i�f lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> i <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 _--_.-.--_-------___....� <br /> Ci�pacitY . .' -TY.pe terial---- ---------------- No. Compartments ----------------- <br /> ----------- W <br /> Distance to nearest: Well -------------------- --------------- undation ---------------------- Prop. Line ---------- ---__,_--O <br /> ,k v <br /> LEACHING LINE [ ];# No., of Lines -{------------------- Length each Ii e.-..-__--__-_-------------- Total Length -----------------`"T ,------_-_--- <br /> D' Box _______- Type Filter Materi ------------ --_--Depth Filter Material ----_.____.________________._...'.________._ <br /> E i i� <br /> U'3�' Di�stancery o nearest: Well ----------- ---- ------ F undation -. property Line ------------ .......... <br /> SEEPAGE PIT [ ] r -- Depth- -- ,--._-_�i7iameter- _fi---_----- Number -------- ------------------- Rock Filled -Yes ❑ No <br /> f Water Table. Depth; = ' Rock Size <br /> i - . ti• -------------------------------- <br /> 0 <br /> - <br /> Dis#ante to nearest: Wel! -- --- ---------4-- _-- ----------_----Foundation Prop. Line -----------•-•- <br /> i <br /> 1 <br /> REPAIR./ADDITION(Prev, Sanitation Permit# ------- ------------- ' -_----------_ _ -- pate -----------------------------_____) � <br /> Septic Tank (Specify Requirements) -------- -------- ------------ ------------------------------------------------ - <br /> Dispo al i ld (S �e�jcify 1 Requirements) <br /> �-------------------------------------------------_--------------�--------------- ------------------------------------------------ <br /> ��VC--� C° Z "70 frn� •� �r------------------------------- <br /> ----------- <br /> X 1 a--x----- Lt-------- <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 /> "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 /> Signed -V�- <br /> Owner <br /> -- - IL <br /> --------------------------- - -- -- <br /> BY ---- - T '. Title <br /> --------------- <br /> (If other than':own r) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTEp BY - � __ -- 2�L_. _ <br /> BUILDING-PERMIT-_1SSUED ------------------------- ~.: -Y. ;:` s = ------------- <br /> �� :w :' :::.: ---DATE ---- - __-- <br /> . <br /> :. - _. <br /> ADDITIONAL COMMENTS_ - --------- ------------------- ----------------------------- ----------- ------------------- <br /> ------------------------------------------ ih- <br /> ----------------------------------- --- <br /> ----------------------- -------------- <br /> - L- --- <br /> �,/ <br /> ------- <br /> FinalInspection --r-------­­------------ --------------.Date ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />