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FOR OFFICE USE: _ <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------------- --------------- -- l <br /> ,, `' (Complete in Triplicate) Permit No: _7 T" <br /> --- ---------------------------------------------- <br /> ------------------- X This Permit Expires 1 Year From Date Issued 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 T�r ad in c�ry�plianc ith {ou #i Or inance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION --------- J -- Vy---------� -- --4--------------CENSUS TRACT 7 <br /> --- <br /> Owner's Name --------- -` � ------ -------Phone 3�( ---rl---- <br /> hh ��/ /� ------------------------- <br /> Address - ----------i_ -----141 4ss,_"-.- __. City ��'"�" ---- <br /> Contractor's Name -- ------------ ---------------------------------------------- ---------License # ---------:-------------- Phone --------------- -------------- <br /> Installation will serve: Residence Apartment House-[] Commercial ❑Trailer Court i❑ <br /> llMotel F1 Other -------------------------------------------- �. <br /> Number of living units:_-A_------ Number of bedrooms -----3 <br /> ------- Grinder ------------ Lot Size ------ "- -------------------------- <br /> Water <br /> -----------------------Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------.Private.41 <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan jr 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.) f <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT 17 SEPTIC TANK�j Size-__- -` �----------______- Liquid Depth -_y-------------------- <br /> Capacity 1,XAq---- Type--4 --_ Material- �__----.- No. Compartments -'�"'................ <br /> Distance to nearest: Wel! -. --------------------------Foundation --- -�-_------.-- Prop. Line ----�-._...-____--__- <br /> LEACHING LINE pq No. of Lines __2---------------- -- Length of each line-----14 > --.------ Total Len trh <br /> :�" - .......--_-__. <br /> D' <br /> Box _ -- Type Filter Material __ -------Depth Filter Material -- ------------- --------__•-__---_ <br /> Distance to nearest: Well ------------ Foundation ___ _ ------------ Property Line ------------------------ <br /> SEEPAGE PIT Depth -$7 ------- Diameter ---------------- Number ------ -1;7____ -______- Rock Filled Yes,8 No <br /> Water Table Depth --/ ---------------------------------Rock Size ----'y+"-�-------------- <br /> Distance to nearest: Well __- -------------------------- <br /> Foundation __ --- Prop. Line ------..__-._---.-_.__ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----------------`------------.....) <br /> Septic Tank (Specify Requirements) ----------------------------------------------------------------------------------•------------------•----- •----------- <br /> Disposal Field (Specify Requirements) -------_ -- € <br /> ----------- ------------------------------------------------------------- <br /> -----------.--------------- --------- ,.. ---------- ------------------------------------------------=-------- <br /> ------------------------------------------- -------------- <br /> m ��—,--- {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 heco_ to W 'km Css Compensation laws of California." f <br /> Sigd _. - �".m.'. ' ` -------------- Owner <br /> BY --------------------------------------- ............ Title <br /> --------------------------- - ------------------------ - <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY 2r <br /> rg <br /> APPLICATION ACCEPTED BY ------ <br /> BUILDING PERMIT 155U)rD G---------------------------------------------------------- -------DATE -------- ---------------------------------.. <br /> ADDITIONAL COMMENTS -------------------- ---- <br /> --------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- <br /> ---------------------------------------------------- ------------------------------------------ -------------------------------------- --•---------------- <br /> --------- <br /> - - - - ------ <br /> �� _✓ ---------------------------- ----- <br /> Final Inspect-ionY .Date d leS <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />