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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - ------------- l f, 00_ <br /> -----� -�--------------- �,�,Q (Complete in Triplicate) Permit Na. <br /> This Permit Expires 1 Year From Date Issued Date Issued /_- . <br /> 7S 1 E 1--C(6�-c w r4�� t Z S( — C110 ! <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct a d install th��e,� p�hherein <br /> described. This application is made in compliance with County Ordinance No. 549 and existin RW _nd¢T2egulation' : <br /> JOB ADDRESS/LOCATION . - b.CENSU�GCT <br /> Owner's Name ------- ------- ---------- --- ------- ---Phone ----------- -- -----------•---- <br /> a-o <br /> Address ---------Fo = ---- Ci '' ' ------------------- <br /> - -- -------- -- - - -------- ----- ----- <br /> Contractor's Name ____._ . _ ----_--�� _____.License # IZA hone __- <br /> Installation will serve: Residence Apartment Ho se❑ Co erc'ial nTrailer C urt <br /> Motel ❑Other - -!' <br /> Number of living units:____ Number of bedrooms ------------Garbage Grinder __ 7___ F„ of Size __ _ ________________ <br /> Water Supply: Public System and name ------------------------------------rz_----------------_-_________---------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam <br /> 3 Hardpan ❑ Adobe ❑ Fill Material ._'Ad 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 seep pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK'[. Size_ __,'f ___�`-S .____-- ---- Liquid Depth ___A/------------------ <br /> Capacity <br /> ----------------- <br /> Ca acit ��.//__�� <br /> p y Tia___ __ Type _________ Material__-- No. Compartments __�_.......... °fl1 <br /> �- o <br /> Distance o near t"Well 1�®_________________Foundation ------/0 Prop. Line _______________.f.... <br /> LEACHING LINE [P.KNo. of Lines _____._�___.__._ length' of each line------low..--_.______ Total Length __ ......._... <br /> 'D' Box _ ype Filter Material _� •___�_____Depth Filter Material _____— - f l <br /> Distance/0 nearest: Well ------- Cid_____ Foundation ----------- Property Line _ -- ----- <br /> SEEPAGE <br /> -...SEEPAGE PIT [ j Depth ____________________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No <br /> Water Table Depth ---------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ________________________________________Foundation ---------- Prop. Line ___.____..________-- � <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------- -------- ------------------ Date _-__, _______________-.______-___J <br /> SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------------- ------------------------- <br /> N <br /> Disposal Field (Specify Requirements] -------------------------------------------------------------------------------------------------------------- ---------------------- <br /> -------------------------------------------- ------- ------------------------------------------------------------------------------------------------------ ---------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepares) 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 -------------------------- ---6wrrsr- <br /> -- Title ------. --- - ------ --------------- <br /> (If other than ownerl <br /> FOR DEPARTMENT USE ONL <br /> APPLICATION ACCEPTED BY ----- ------------------------------------ DATE ------------------ <br /> BUILDING PERMIT ISSUED -- - .--- •--------------DATE -------------•----pp------- ------- <br /> ADDITIONAL COMMENTS - -- - 1------ -- --------- /���= =6C------ <br /> ____ti _ _______________________________________________________________________________________ --__r___ <br /> _____________________________________________________ __ ______________________________-________________-._..___________------------_ ----_-._----____- <br /> _ <br /> Final Inspection by: --- -- -- - ---------------------- -Date - - -- --- ------j----------------- ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />