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FOR OFFICE USE: <br /> --------------- <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate} Permit No. --73' <br /> ---------- -------------------------------------- ----- 3- 7-3 <br /> ------------------------------------ This Permit Expires i Year From Date Issued Date Issued -Z -- ..-- <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/LOCATION .-- - !_-------- ------- r; ..G ' ----- -------_— CENSUS TRACT --S-y7---.----------- <br /> Owner's Name ----- 'Ocat ----------- ----- -- - -- --- -----•----•-------- - -- -- -------------=-•-------------------Phone ------------------------------------ <br /> Address 1 f ��a f ------------- <br /> ------- <br /> �'y rr ._.. City -- -��'f ---------------------------------------------•------ <br /> Contractor s Name, .�__ �;_ - ------- -------License # ------------------------ Phone ------------------- - <br /> Installation will serve: Residence„(]Apartment House❑ Commercial ❑Trailer Court F] y <br /> j Motel F-1Other -------------------------------------------- <br /> Number of living units:---!_----- Number of bedrooms __-'V------Garbage Grinder -------- ... Lot Size `�------- <br /> Water Supply: Public System and name ---------------------- --------•------------------------------------------------------------------------------Private p <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 /> (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,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK A-] Size--_--'----------------------------------------- Liquid Depth ----------------------.--. <br /> Capacity/r-Q-b__------ Typ - Material---------------------- No. Compartments ,?------------------ -- <br /> DistaDistance --------------Foundation - --- .0 S <br /> nce to nearest: Welt/ __________ �_ __________ Prop. Line __ Q______-_____. 6 <br /> LEACHING LINE No. of Lines -9------------------ Length of each line.j_/-_______________ Total Length ----�`P_o------------ <br /> ` <br /> 'D' Box _-- Type Filter Material --------Depth Filter Material --/-?----------------------------------z <br /> �------------ Foundation ------a_`------------ Property Line __�0_+ ' <br /> Distance to nearest: Well __�____._ '� ______._.___ <br /> SEEPAGE PIT ( ] Depth _ ______ Diameter �Z----- Number _____�_______________ Rock Filled Yes No <br /> Water Table Depth J-6-6 <br /> ------------------------------------Rock Size --- -------------------------- <br /> Distance to nearest: Well _16Q-----------------------------Foundation Prop. Line .......... j <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ________ ----------------------------------- Date ._____-___-_________.__________} <br /> Septic Tank (Specify Requirements) ----------------------- --------------------------------------------------------------_-------------------------- <br /> DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------- ----------- -------------------------------------------------------------------------------------------------------- I------------------------------------------------------------------ <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 beco a subject to Workman's Compensation laws of California." <br /> Signed ---fi�&x-C-- . --- ------------------- Owner <br /> By --- ------------------------------------ ----------- Title ---------------- <br /> --------------------------------------------------- <br /> ---------------------------------------------- <br /> (If other than owner) <br /> Ar FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ _ DATE _.______�_ _ <br /> - - <br /> BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS ------------------------------------------------- - r <br /> --------- <br /> -----------------------------------------I------------- <br /> ---------------------------------- ----------- ---------------------------------------------------------------------------------------------------------------------------------Final Inspection b ` <br /> _______________Date <br /> SAN JOAQUIN LOCAL HEALTHr DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />