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Y <br /> FOR OFI ICE USE: AppLICATIOIr+!'FOR SANITATION PERMIT <br /> --------------------------------------------------------- _. <br /> ---------------------- <br /> }(Complete in Triplicate) Permit No. ._�___".�O_______. <br /> ---------------------------------------- - --- - ' <br /> -- ---------------- This Permit Expires 1 Year From Date Issued i Hate Issued <br /> � 1 , <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 /> JOB ADDRESS/LOCATION .Za�f., __,_ �.._____�Q_t _____�-6� W A�---CENSUS TRACT _____-____--Q............. <br /> Owner's Name l�il6_�.j ----- `, �-----------=-- --- -------Phone ,�Xr-/e <br /> F <br /> r` <br /> Address --------------------=--- -- -- - ---------------------------------------------------------------..Cit - r------ ------- --- ------- -------- -----------•------ <br /> Contractor's Name - - c-- i¢ i$ 9`- � ----------------- ;-.Lnse # 6'f>, - ---------- Phone¢--- CX', ---• <br /> Installation will serve: ResidenceXApartment.House-❑ Commercial ❑Trailer Court ,❑ <br /> Motel ❑ Other ----- -----------------' - ...... <br /> , h <br /> Number of living units..---/----- Number of bedrooms '---_Garbage Gririder .__-_______ Lot Size ! -"e <br /> Water Supply: Public System and name ----------------------------------------------------- ----------------------- -----•--------•-- ------Private ❑ i <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peeatr❑ Sandy Loam ❑ Clay Loam .Fl <br /> Hcirdpan'❑ Adobe'❑ Fill Material ------------ If yes,type ---------------------------- <br /> (Plot <br /> __-_______--_-_-(Plot plan, showing size of lot,' location ofsy�stemginTr`elat nit Wwells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] W <br /> PACKAGE TREATMENT f ] SEPTIC TANK[ ] 'Size------------------------------------------------ Liquid Depth ----------------_- <br /> I <br /> .r 1R `. <br /> Capacity ;..- --TYPd_z7--xi------- Material No. Compartments ------ --------------- }► <br /> Distance to nearest: Well _ ___ -------------------Foundation ---------------------- Prop. Line ---------------------- <br /> LEACHING <br /> --_____________-____LEACHING LINE [ ] No. of Lines ______________________ Length of each line---------------------------- Total Length ____________________________ <br /> 'D' Box ------------ Type Filter Material _______________ ___Depth Filter Material __-_____-_______--_.._.-_---_______-_.____._ <br /> Distance to nearest: Well ______________________ Foundation ________________________ Property Line, --________-_______-_.___ <br /> -- Rock Filled Yes f <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ------------------- -_-- ❑ No i❑ <br /> Water Table Depth -----------------------------------------;- --.Rock Size -------------------------------- <br /> Distance to nearest: Well ---------------------------------"- _._Foundation -------------------- Prop. Line _.----------__-------- � <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------- <br /> Septic Tank (Specify Requirements) v <br /> " 1 ----L.B+ ��__ ttY! ---____/_elf �<.t_____O_ ./sFiet�____�!Sl <br /> I <br /> Disposal Field (Specify Requirements) oo�lC i-lf,OtSlt¢V------- -------- L'kt`A!E_--------(6A, <br /> 4". .......AtAr •r� __�3 `=x. ,S' �tT'------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will bedone in accordance with San Joaquin <br /> t <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Horne 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 /> Sign -------------------------------- Owner } o <br /> By Title -. <br /> - ------------------------------------------ <br /> If other than owner] _a <br /> FOR DEPARTMENT USE-ONLY � <br /> APPLICATION ACCEPTED BY - - --- ---- - - -- -- -------------- ---i----------_ DATE _ .: _ _"Z�------------------- <br /> --------------------------------- -- <br /> -- <br /> BUILDING PERMIT ISSUED _. DATE --------------------------------- -- <br /> -;r--------- <br /> " = A <br /> ADDITIONAL COMMENT � 7-- ----------�'y,y",rl----G� '�1 <br /> - _/ �___ ___ _ _____ _____ ______________5_ ---_----------------------------------------_-------------------"-----_- <br /> S <br /> ____________________________ _________ _________________ _______ ___ ________________�____p:_______._-_-__-___________-___-____________-_____ __-______--__---_.___.-____________----_ _ <br /> rte: --- _ <br /> --.Date <br /> Final Inspection by: __. _ -- --=------ ----=----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ­E.-H, 9 1-'66 Rev. 5M <br />