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FOP-OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------- --- <br /> (Complete in Triplicate) Permit No. <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> ____________ <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-incompliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> �3i 3�'sS <br /> JOB ADDRESS/LOCATION ---- 5^-- =:_-- �•�4- I----rf "--�lrr -Fj'� !-.-CENSUS TRACT -------------------------- <br /> -------- ------ <br /> a. - 5-7C1 -bi <br /> Owner's Name --------� ri 5--------. � f+?i 5 --------------• -------------------------------- ----- -------Phone <br /> Address -------- -� f 4'^e*�-----------------------. Citi `� •-------------------------- <br /> .- )- q 1 <br /> Contractor's Name ----------C-.---01_ --r`.c- _f_yn_ films-------------------------License # �C1-.�1 7�+ Phone cJ�t I- �IY_-....... <br /> Installation will serve: Residence [Apartment House-E] Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other ---------------------------- --------------- <br /> Number of living units:________ Number of bedrooms _- ------Garbage Grinder A0---- Lot Size __/7--7245_J-0 <br /> ---------------------- <br /> Water Supply: Public System and name ---------------------------------------------------------------------------------------l-------------------•-Private <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 /> {Phot plan, showing size of lot, location of system in relation to wells, buildings, etc. must, be placed on reverse side.) �3 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) - < <br /> PACKAGE TREATMENT [ SEPTIC TANK Size--------1d__a._-19___y�_f____._______ Liquid Depth --- 5__ ............ <br /> f� <br /> Capacity -�a3crZJ------- Type cT_�"G--�`;7 - Material-- �K.f._____ No. i Compartments ---;�-________---_ <br /> Distance to nearest: Well ---------2 _t_________________Foundation -------- Prop. Line __ ____....._.______ <br /> LEACHING°L'INE [ ] No. of Lines ---------3----------- Length of each line---------------------------- Total Length .___--_____- ______________ <br /> 'D' Box ------------ Type Filter Material ____________________Depth Filter Material -----------------------------..-_____._.__-_ <br /> Distance to nearest: Well ------ _______ Fo6ndation ----- '_______ jProperty Line ________________________ <br /> SEEPAGE PIT [ ] Depth ------------------ - Diameter ---------------- Number ------------- ------------- Rock Filled Yes ❑ No <br /> E <br /> Water Table Depth ------------------------------------------------Rock Size ------------------------ <br /> Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line _____-____.._......... <br /> REPAIR/ADDITION{Prev. Sanitation Permit#I-------------------------------------- ---- Date ___.______________________________) ! <br /> SepticTank {Specify Requirements) ----------------------- ------------------------------------------ ------------------------ ------------------------------------------------ <br /> 9 <br /> Disposal Field (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 Regulat]on's 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 WV rkinan's Compensation laws of California." <br /> ,, //�� 4a --------------- Owner <br /> Signed �L �-----�� - ------------------ <br /> J <br /> By ----- 4 .<� Title ._ - <br /> /r't g� -- <br /> � 4, <br /> (I othf�er than ownerl', 0 <br /> i FOR DEPARTMENT-USE ON <br /> yF <br /> APPLICATION ACCEPTED BY -- =r = DATE <br /> f+� <br /> BUILDING PERMIT ISSUED ------------------- <br /> ------1 - ------P <br /> -------------DATE ------------------------------------------- <br /> - ----------------------------------- <br /> ADDlTIONAL COMMENTS ------------ ----------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- <br /> - ------------------ ---- <br /> - - <br /> Final Inspection by: ----------------------------------------------------------------- ----------------------- -------Date $- `1- -- ------- <br /> SAN JOAQUIN LOCAL HEALTH TRICT <br /> E. H. 9 1-'68 Rev. 5M <br />