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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ---4n J a — ��. permit No: -7.1-Oo - <br /> (Complete in Triplicate) <br /> --------------------- -- --------------- i0 7z <br /> 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 per 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 /> G ---------------------------------------CENSUS TRACT --------------------•----- <br /> JOB ADDRESS/LOCATION ._�_�_�_i1----- -- - - - -- -- ------------ --C-- � p <br /> Owner's Name - .` Phone <br /> Address ------------------1.t-7- ------ -- -- - --- ------------------------------ . City�.LC� -" ---------------------------------•----------- <br /> Contractor's Name fTzc --------License #G6 -SW----- Phone 7`�c16-r <br /> Installation will serve: Residence tApartment House❑ Commercial :❑Trailer Court i❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:------ Number of bedrooms ___`]Garbage Grinder --- ________ Lot Size _______________-__._______--.--_______---- <br /> Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'E] Silt❑ ' Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe-❑ 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 <br /> p seepage pit permitted if public sewer is available within 200 feet,) �r <br /> PACKAGE TREATMENT [ I SEPTIC TANKSize___��___7�.-_ ------------ ------------ Liquid Depth _$_ ________--.___ <br /> Capacity J -- Type Material___ -_ No, Compartments ___ .._.____.__. <br /> Distance to nearest: Well ____________________________________Foundation _.__ --------- Prop. Line __--­--_---'_____-- <br /> LEACHING LINE No. of Lines --------f"-------------- Length of each line----/C.0-------------- Total Length _A70.---------------- <br /> 'D' Box ------------ Type Filter Material h ______Depth Filter Material ___ __ ____ _____________________________ <br /> Distance to nearest: Well ________________________ Foundation __/0--------------- Property Line _____..------ <br /> __.------- <br /> SEEPAGE PIT f Depth ____� _`___ Diameter _3,3-_*'r____ Number ----------/---_____________ Rock Filled Yes w No i❑ <br /> rr r/ <br /> Water Table Depth ---------------------------------------=--------Rock Size ..... <br /> Distance to nearest: Wel! ________________________________________Foundation -1-D y`-___ Prop. Line _. -------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ___________________________________________ Date _______-_____.______....__._._____) <br /> SepticTank (Specify Requirements) -------- ------------------------------------------------------------------------- -----------------------------*---------------------------- <br /> Disposal Field (Specify Requirements) -------------------------------•-------------------------------------------------------------------------------------•--------------- <br /> -------------- ----------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------•-•-I---- J <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 ------- ------------------------------------ ------- -------------------------------- Owner <br /> BY ------------------- Title <br /> ---------------------------------------------- <br /> (If other than ow <br /> �FPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- --------------------------------------------------------- DATE ---- F- 6- -7 <br /> BUILDING PERMIT ISSUED -------- - - ---- - - -------DATE .----.----------_------_-__-_ <br /> - <br /> --- - ----- ---- ----------- ------------------------------------ <br /> ADDITIONALCOMMENTS - ----- ---- y-------- - ----------------------------------------- ------------------------------------------------- <br /> ' d= 3 ���` .� , ------------------------------------------------------------------------------------- <br /> -------- ------- -- ------------- --------- ---- - - -------------------------------------------------- ------------------- - -- -= <br /> -------------- --• ------- <br /> Final Inspection by: -- --- = : - - - -----------------------------------------------------------------------------Date ------ � r�5------------- <br /> / N JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />