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FOR OFFICE USE: F - <br /> . - yAPPLICATION FOR SANITATION PERMIT <br /> -------------------------------------------------------- <br /> Permit No. <br /> ---------- --------------------------- .____----- ��-� ' <br /> JCornpL,to in Triplicate] -- - __ ....... <br /> , .�,r y; _,.. -- s �� r_.•.. . ' . _ Date Issued ._./-L_ -_7.Z <br /> his <br /> --------------------------------------------------------- <br /> Permit Exrire§ 1:Year From Date Issued <br /> Application is hereby made-to-the San Joaquin Local,Health Distr..ict_,for a .pe�Mit-to construct and install the work herein <br /> described. This dpplication is trade in-compliancedwith County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB.ADbRESS/LOCATION. _ . #._ --- -------- -------- �- --- SUS. <br /> TRACT -------------------------- <br /> Owner'S <br /> Name ------------------ - -- --- ----- .---------- ------ ------Phone --------- <br /> 4 <br /> ______ _ __ _ <br /> Cit <br /> Address :•- - - -- ---------------------------------- <br /> I <br /> ----------- --------------- F <br /> /2 r <br /> - s p& <br /> Contractors Name --- - -- -- - ----- - _ --__-•�-_______.License # -�1�_ -- Phone <br />,,,.io.�Instal.latiori will serve,-, a Residence YApartment House,[] Commercial :❑Trailer Court <br /> 'A Motel j]Other ------------------------------------ ----=J <br /> Number of living units:i___.--_i�' Number of�bedrooms _�-p_--Garbage Grinder ________-_ Lot Size •1--.----'-__- <br /> WaterSupply:_Pub(iystem!and name -------------- ---------------------I--------------------------------------- - ---------------- --------: -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 />-:�C_ -(PIoF;plan, showing size:of'iot, location of system in relaton to wells, buildings, etc, must be placed on reverse side.) ! <br /> _ <br /> . NEW INSTALLATION: `(No Septic tank or seepage pit permitted if public sewer is available within 200 feet,l $. <br /> {; t <br /> PACK-AGE*TREATMENT, {�]p SEPTIC TANK' JZ_ <br /> e-_-_ _:= - ___._'____.----_'._:--_ Liquid/17!,Ca acity�� CI__ ___ _.__ Type - _ _ Material--(.A~u�_ No. Compartments "� <br /> .Distance to nearest: 1VOI---__�________________________Foaridation _-_�_S�-_._--_----- Prop. Line .__-�._.... ...... <br /> ;[_EACFiING:.LINE�.� No. of Lines ----_-. --- Length of <br /> each line_----__ -------- Total Length ....... <br /> "D'-Bax Type Filter Material ---Depth Filter' Material -------1uP------------------------­ <br /> Distance <br /> ----------------------Distance to nearest: Well ------------------------ Foundation __-_ Property Line __ -- <br /> SEEPAGE PM [ Depth _. _ - --------- Diameter _53-------- Number -.--.--.y.------------ Rock Filled Yes No_i❑ <br /> Water Table Depth ---------------•----------------- -------Rock Size ��--... 5----------- <br />_� 4 ,`mss- ---------------Foundation _ d r Prop. Line,--�.__.-.-.._.. <br /> „ Distance to nearest: Well ___________________________ _ ii , _ <br /> REPAIR/ADDITION(Prey.,Sanitation Permit* --------.----------------------------------- <br /> Date ------------'---------------- <br /> Se tiCTak I5 ecif Requirements) - - --- <br /> -- -) <br /> ---------------------------------------------------------------------------------------------- -------------------------- -- <br /> 'Disposal Field' (Specify Requirements) _-.-----�-_= = ---- --------------------------- ------ <br /> " - # ----- ----------------- <br /> = - - <br /> ----- ` --------- -- - } <br /> } (Draw existing and required addition on reverse side) <br /> Thereby 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 <br /> I ... .. <br /> ----- - _- - --------------- <br /> ---.�---�-----_ <br /> ----- Owner <br /> SY --------:-d-� -- - -- T <br /> -------------- <br /> -- ! itle' $ ------------------------------------------------------ <br /> (If of than owner),,-, <br /> FOR DEPARTMENT USE ONLY 1, <br /> `APPLICATION ACCEPTED BY ---------------- -------------------------------------------------- DATE — ------------- <br /> BUILDINGPERMIT ISSUED --------------------- --- --------- ----------------- --------------------- -- -------- -----DATE -- -- ------------------------------------- <br /> ADDITIONAL COMMENTS - -----------------------------=--------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------- <br /> -- -------------- ---- - ------------------------ . ---------------------------------------------------- ----------- ---- <br /> - - -- f� 1 <br /> -- --- - - - - - - - - - - - <br /> ----- ---- --- --- ------------------------------------------------ ----- - --- - -- ---- ---- --- -- - <br /> Final Inspection by: = ---- ---------- - Date __ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />