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R9 <br /> ' �• � FOR OFFICE USE: <br /> APPLICATIOW FOR IANITATION PERMIT f j <br /> ........ 73 3 3 <br /> (Complete in Triplicate] Permit No. _......�____7_.... <br /> . This Permit Expires T Year From Date Issued Date Issued - ..... 3 <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 mad in compliance with County Ordinance No, 544 and existing Rules and Regulations: <br /> JOS ADDRESS/LOCATION ...... -- � _.. .._•/-•.------ ![ ..t!_ ..... .....................CENSUS TRACT .......................... <br /> •• - — ,� yam, - ._. . _ <br /> Owner's Name .._.. ,f�-1---------- .. 1 �.r . ., <br /> ' -• ---.._._..Phone---------------•-:.. ..--------- <br /> Address ti .. Cit <br /> • _ <br /> Contractor's Name .... _.. __! ........................................License------------.License #-a.P,/ .... Phone <br /> Installation will serve: Residence ] artment House C] Commercial :❑Trailer Court i❑ <br /> Motel ❑Other <br /> ............I............... <br /> �um <br /> 4 bof living <br /> ` s --.. Number of bedrooms _ <br /> ......Garbage Grinder <br /> Lot Size <br /> t <br /> Water SupplyPublic System name .... J <br /> -------- -------------------------------------------- - ------------------------------ I <br /> ------Private �►. Y <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay E Peat❑ ,Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material _. 'a`'�7 If yes,type ------­---------­----- <br /> .(Plot <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,),/ 6 <br /> PACKAGE TREATMENT ( ) SEPTIC TANK-[ Size.....�1 ! -------------------- Liquid Depth ... ?: ......--.• (� <br /> Capacity . ... Type _ _..... No. Compartments <br /> -- -•--•-Foundation -- �. / <br /> Distance to{ nearest:'Well' " - � .._ Prop. Line `� <br /> ._ <br /> LEACHING LINE No of Lines c e <br /> [� �-----__--.. Length of a ch line.-. �_ �!,j''"` Total Length ,�--�.L?-•--......... <br /> D' Box ...: -__--- Ype Filter Material .- _-- Depth' Filter Material 1:_/1. .............:..............::..• k <br /> Distance to nearest: Well .... _.............Foundation _ f ...._.. Property tine ..,�. ....... ! <br /> SEEPAGE PIT [Depth :.-. . . Diameter !�._. -`�.- Number ..._..�...... ...___ Rock Filled Yes B.�N <br /> . i <br /> Water Table Depth 4�! Lf _... ...................Rock Size ' <br /> • Distance to nearest: Well ___ -. ..�._. .. _. - Foundation y Prop. Line .. y <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Dote .. .............................. <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) .............................................. ---------------------- .............................. ---------= <br /> •............. ... <br /> _______________ __________________________ ................. .. <br /> ' (Draw existing and required addition on reverse side) t <br /> I hereby certify that I have prepared this application and that the work will;be done in accordance with San Joaquin T <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 $hall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .........m­­:.......•-.••------.��ne <br /> .. .......... Owner s <br /> -e- A <br /> 8y .._... ..- Title .. __.._ .. . ....... <br /> (If other than or.��,. F <br /> FOR DEPARTMENT USE OASILY <br /> APPLICATION ACCEPTED BY:.....�_ <br /> - DATE ..._. .. _ '..... <br /> �_ ...... <br /> BUILDING PERMIT ISSUED ............. •-- . ..: ------ .........DATE ........................................... i <br /> ADDITIONAL COMMENTS <br /> ----------- <br /> ._._....... .... ...:� ---------: : ........................................:...........:...........................:...................................I........: <br /> -•-•-•----------- ----- <br /> Final Inspection by - - . ---- ate <br /> :::::::::::::::::::::::::.:::::::::.::::::_:.::::._:.:.:::..:s.....:::::::::::::.D. � : <br /> SAN JOAQUIN -LOCAL HEA <br /> .. LTH DISTRICT <br /> 13 24 <br /> E. H. 1-'68 items. 5)X� 7 171 q_%f <br />