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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. - _� __-.7_. <br /> QComplete <br /> .'7 <br /> in Triplicate) <br /> -•- .i - - -_ -_ . . _.. t -�. - — .<. ­ . .,. .Date Issued--- -- <br /> --_-----_--------_-----_.----_.----_.--_--------- This Permit Expires 1 Year From Date Issued <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/LOCATInTION -------- �-� s -- ----- � - ----------- ---------CENSUS TRACT -------------------------- <br />{ Owner's Name ------2--------- ------------------- Phone <br /> Address -----= - - City ---- <br /> Contractor's Name .____ License # 0;4^f- _-_ Phane <br /> Installation will serve: . _Residence Apartment House❑ Commercial:❑Trailer Court <br /> Motel ❑Other ' <br /> Number of living units:._1_a-__ Number of bedrooms _______Garbage Grinder ------------ Lot Size ___ ----_-___-_ <br /> Water Supply: Public System and name ---------------------------------------L!.----- --------------------------------------------------------------Private E] <br /> Character.of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay r❑] Peat❑ Sandy Loam ❑ Clay Loam ❑ 'f <br /> i t Hardpan ❑ Adobe Fill Material~'__;------- If yes,type ____________________________ A, <br /> i (PI'ot plan, showing size sof lot, location of sy's`tem in relation to- wells, buildings,, etc. must be placed on reverse side.) N <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT <br /> i <br /> EPTIC TANK'[ Size_________ _______ ___..____ ____-_ Liquid Depth ______-_______ <br /> Capacity ---------- Type = Material =- - No. Compartments <br /> WI <br /> . Distance to nearest:: Well --- ----------- <br /> -Foundation ___..________________ Prop. Line ------- <br />" LEACHING LINE k1 No. of Lines ---------I------------ Len gth_of-e line-------s_�--.------ Total Length __-V30.-- ----------- <br /> D <br /> ` D' Box-- -_ _ --Type-FilterMaterial ---24!�f---r____Depth Filter Material ---------Z9__ ______________________ <br /> Distance to nearest: Well ------------------------ Foundation _______ `` ._7__--- Property Line _____`, ...... <br /> SEEPAGE PIT. Depth ______�`�__s?__!__ Diameter,�l�__-V Number ---_------_!__.--------_ Rock Filled Yes No <br /> i' i� <br /> Water Table Depth --------------�r------1-------------------Rock Size --------,Z -- <br /> Distance to nearest: W61'17'.'------ .-- ------------------Foundat,ion.;,-,__ s Prop. Line ----- ----------- <br /> REPAIR/ADDITION{Prev. Sanitation Permit# -- '- -------- ----------------- Date ---------------------------------- i <br /> Septic Tank (Specify Requirements) - -4------ _ - =,-- - ---------------------------- --------------------- <br /> l -/ ) / /1 en <br /> Field (Specify Requirements) ______ .-:-.--, t. __. ----,--------------- adv-_, <br /> - <br /> -------------------------------------------------------------- --------------------------- ------------- ------------------------------------------------------------------- <br /> i <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 si1-1 <br /> gnature certifies the following: § 1. <br /> E 1 <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 /> ias to become subject to Workman's Compensation lawsofCalifornia.” <br />! Signed --------- ------------- ----------- Owner _...-. <br />> BY ----- ------------------ Title <br /> ----------------- <br /> (If other than owner) rI <br /> t FOR"'DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - � � �--------------- ------------- ---- DATE --- -73---------------- <br /> BUILDING PERMIT ISSUED ----------------------------- '._ - <br /> --- �--`-� ` DATE <br /> ADDITIONAL' COMMENTS ----- ----------------------------------- <br /> ----------------------- -------- ------------------- -------------------------------- <br /> --------------->. _ _>"- <br /> --------------- ----- ------ -------- - _ �_- _ - <br /> ------ -------------- -------- ---- ----�- � i _ <br /> Final Inspection by- ----- ------ -------------------------Ddte _-- -------- <br /> SAN JOAQUI/ LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />