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FOR OFFICE USE: 1 <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------------------------- Permit No: rlo_-- ... <br /> 7\', <br /> (Complete in Triplicate) <br /> This Permit Expires I 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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> - . <br /> - - ---- ---------------------- <br /> -CENSUS TRACT ADDRESS/LOCATION _ --------------- <br /> ---------- <br /> ------------- <br /> f =Owner's Nam -- ---- ----°--- ------ - ---------= <br /> Ph <br /> Address ---------- It - r <br /> - -- --- ----------------- <br /> - <br /> Contractor's Name_ - . _ _...__.:Z.... ._.License # � .0.3 <br /> Phone --------- ------ <br /> Installation will serve: t Residen Apartment House-E] Commercial :❑Trailer Court 0 <br /> Motel ❑Other -------------------------------------------- f <br /> Number of living units:_-:---1----- Number of bedrooms --____Garbage Grinder ------------ Lot Size ___ __3---4•41--Z----------........ <br /> Water Supply. Public System and name ---------- _ -----------------------_________ __:._---------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt ElCla Peat ElSandy loam • Clay Loom.0 <br /> Hardpan ❑ -Adobe ❑ Fill Materialyes,type ---------------------------- <br /> (Piot 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 orsee age pit permitted it publi j sewer is available within 200 feet,)``,J` �� 0 <br /> PACKAGE TREATMENT [ ] SEPT C TANK' Size X_l�___ _ _-__�__N__________ Liquid Depth __7-___-f ......-,____ <br /> Capacity _ �_6 Q___.:__ Type ____ Material-_ . No. Compartments �-------------- <br /> Distance <br /> -----__._-_Distance to nearest: Well ____________ __(2_U__4__w___ .Foundation -----ho--- -------- Prop. Line s._______. <br /> rw <br /> LEACHING LINE ] No. of--Lines -----_c5Z----------- Length of each- line_4--OD—_------- '` Total Length ---Ca_C�..._....-_ <br /> 'D' Box Type Fitter Material -------- ___Depth Fitter Material _ ____________---------------------- <br /> Distance <br /> ______________________ <br /> 44 <br /> Distara�e t nearest: Well ____l._d��_____,_ Foundation ----I_t?fl.________ Property Line ________.-�__._.._..__ <br /> S� [tK 'Deplh';----1.c�-------- ler I_ f0----- Number .... .9---- ---------- Rot ,Filled Yes g o i❑ <br /> Water.,_Table,Depth---------------`� ------------ _ ::_:.::Rock Size° -� d� X <br /> ---------- <br /> Distance to nearest: Well --------1_--sO_l_________________-Foundation Prop. Line ------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------_----------------------------------- Date ----------------------------- <br /> -- --- <br /> Septic Tank (Specify Requireme�its).....-. -,�..:... ---- - -------------- -----=--------,..----------------•-•----.... <br /> Disposal Field (Specify Requirements).--------------------------------------------------------------- - ---------------- ------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------- <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: f <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 t Workman's om sation laws of California." <br /> Signed ---------------------- - --- ------ - - Owne <br /> By ----------------------------- -- ----- ------ ---t ----- Title ---------Q <br /> --- -------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED = DATE -- - 7?- Q----------------- <br /> BUILDING PERMIT ISSUED - -------------------------------------------------------- -- -------------- <br /> -------------DATE -------------------------- ----- <br /> ADDITIONAL COMMENTS ---------------- ------------------------------------------------- --------------------------------------------------------------- --------- -----•----------- <br /> -------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- <br /> ---- ---- -- -- - -- -------------------_--- - ------_----------------------------------------- " <br /> ------- - - - <br /> ---- --- -- - <br /> Final Inspection by: = --------------------__--------------------------------- --------- -------- --- - ate <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M, <br />