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`-` FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT T y <br /> ..............•--•-•.-..................._--- ---- a <br /> --.... <br /> - ------ (Complete in Triplicate) Permit No. -7�� <br /> .....................................•- ---...-..._...-. <br /> ! I 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 permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations. <br /> JOB ADDR/ESS/LOCA�T ---- ---- --- <br /> E ft/a ...._ <br /> s <br /> ...CENSUS TRACT ....................... <br /> --Owner's Name <br /> Addre City ••--- . ............. :..ss .......... -- ----- <br /> Contractor's . <br /> Name - ---_-.License ��� <br /> Installation will serve. } Residence ❑ Apartment House❑ Commercial ❑Trader Court l <br /> 1 E i Motel Q Other _...�� ------- ---------- -- 4 <br /> E / <br /> Number of Giving units:-.f`j'Number of bf drOOmsf-1- <br /> ---Garbage tinder lot Size �-__e��-.Ie _�-�K...__...... . <br /> Water Supply: Public Systemand name _. - ----------- •- A.-----------------...------__--.- <br /> _------.-_ .........Privatex <br /> Character of soli 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 plprmitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ]- SEPTIC TANK j ------------------ .................. <br /> .... Liquid Depth -------.................. <br /> . <br /> CaPacity .-;. ._.... .._... Type ----- ........... Material.............. ....... No. Compartments ---------------- <br /> __ -•• <br /> Distance to nearest: Well . ....__.-- .................Foundation ...._.-__...-!........ Prop. Line ..__._._...___..__... <br /> `fir f f / <br /> LEACHING LINE No. of Lines ,.v2- ... . -. Length of each line ..�0.. _____________�-_ Total length .+� .................. � <br /> 'D'-,, Box - `.-- Type Alt& Material Aoca.......Depth Filter Material :��.F_�...__...___________________ <br /> ( .............. <br /> ) .r <br /> � E <br /> Distanc_ett�`rest, WellqZ�,�.�---.._-FNumberon--/ -. .... •---._ Property Line �..................... <br /> �C <br /> SEEPAGE PIT Depth Diameter .,_.............. Rock Filled Yes& No �] <br /> Water Table Depth ----------------- <br /> _-•-- -- •----•----..._..Rock Size -.-�--`�-----------__._. <br /> I1 .{{ ! ` / <br /> Distance to.pearest: Well --_c�CQ-Q---------------_-___-Foundation /..d..... Prop. Line __s _..__._.._.__ <br /> _._. __ r <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------__________-_--- Date ....------:......-................ <br /> } <br /> Septic Tank (Specify Requirements) .. ----------------- ----• .... <br /> Disposal_ Field (See 'fy Requirements) -. �Ji:e, . ' ,....__, .- ............. <br /> ------••-------- ------ -. r ..--- F -.------------------------.._....- ----------"-----,.... ........................................... <br /> . .... -P- -------------------------------------------------.....................'-------_.__....--------------- ------------------•--------------•----- <br /> t (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 .:........... ......-_.i...... ......- .... $-._ Owner <br /> BY <hg _ ------ ... • :_. Title ....... <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -.. - _..___---__. DATE ..j.t�.? ' <br /> '1? ___•--___-.. <br /> BUILDING PERMIT ISSUED .... •-•- --........... ..............DATE . _.... ------ <br /> ADDITIONAL COMMENTS ............ .... ----------------- •- --•----- -• ---• <br /> ----------------------------------------- <br /> + ; <br /> ---------- - ------------------------------ -• _ <br /> .• - - ---------.... .....----- -- ----------._...----.-------------._.._...__.-..._...••-------------- ------ -------•-•-•---------------------•--- <br /> i <br /> •..---- ----- --- _------.- -. -------------- ------•---•--•---._-.__.._.....---•---....._...... <br /> .................... <br /> .. .- -- - .-' _'3-----------------------'------_....._..__.-.. _ ......... <br /> ­ <br /> _­ <br /> Fin Inspecti n by: -'- ._�,....-.- ...... .......b-.a„_5.-•----•-------- ..__....Date�� .�G --. .._ .:.__..___....... <br /> fir- SAN JOAQUINV LOCAL HEALTH DISTRICT- <br /> N z 1_ AA Da., SAA y 7 79 'A H <br />