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FOR OFFICE USE: <br />---- <br />APPLICATION FOR SANITATION PERMIT <br />Permit Na- <br />----------- --- ------ <br />(Complete in Triplicate) <br />I- -------------------- Date Issued <br />_ J <br />----------------------------------------- __________ _____ This Permit Expires 1 Year from bate Issued <br />____________ <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 gulatio s: <br />J08 ADDRESS/LOCATION . //-------------------------------------------------------- CENSUS TRACTk.. <br />Owner's Name ��` �7l9 ll� Phone .�-:!_ <br />---------------------------- - - ----- <br />---------------- ------ <br />40 <br />Address ---- it . (city -------------------------------- --- <br />G---- ------ ---------- <br />Contractor'sfame .__ _._ License #o�-- -f �d �_j vs�._% <br />R (-"" i l `--------------- 5 --- Phone 4.�,�--- <br />Installation will serve: Residence Apartment House Commercial Trailer Court <br />Motel ❑ Other ----------------------------------fir <br />Number of living units:---/ ------ Number of bedrooms _______.Garbage G3rinderD"1 _ Lot Size _ 1 ........ <br />Water Supply: Public System and name .- =-------------------------------------------- - _•.` !----------------------------------------Private <br />�. �.....,� <br />Character of soil to a depth of 3 feet: Sand'❑" Silt E] -day ❑ ­Peat'E-]: <br />Sandy Loam ❑ Cl— <br />Sandy Loani <br />Harcipan.-N Adobe -❑ Fill Material ____________ If yes, type ---------------------------- <br />(Plot <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 permitted if public sewer is available within 200 feet,) <br />PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size ------------------------------------------------ Liquid Depth -- �^----------- <br />Capacity i _ d.____ Type `4_JZ _� Material p_N_CjZ-7t Na. Compartments _ ______________ 11 <br />Distance to nearest: Well __C_Q______________________Foundatiop --- 1.0----------- Prop. Line -----6 ------------- <br />LEACHING LINE [ ] No. of Lines ..---. �?------------- <br />- Length' of each line ----- tJ�_____________ Total Length <br />k2�!_-1--9 <br />___1 4 0 •_•_. •_"_•_ <br />'D' Box ____/_____ Type Filter Material __-Depth Filter Material _/ 9-"/f ......... ................. <br />Distance to nearest: Well -------- Foundation `_______ Property Line .�`7-------------- <br />SEEPAGE <br />_____.__._ <br />SEEPAGE PIT [ J Depth --,� _ c3 ____ Number _____�__________________ Rock Filled Yes [R No i❑ <br />---____-- Diameter _-' ____-- <br />Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br />Distance to nearest: Well -------- -------------------------------- Foundation --------------- ---- Prop. Line -.------..._ ......... <br />REPAIR/ADDITION {Prev. Sanitation Permit #-------------------------------------------- Date _____--_______-___--____________) <br />SepticTank (Specify Requirements) ---------------------------------------- ------------------------------------------------------•--------,._- <br />DisposalField (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: <br />"I certify that in the performance of the work for Lich this permit is issued, I shall not employ any person in such manner <br />as to becom ubjec to Wor an's Compensati. laws of California." <br />Signed - _. <br />-- --------- -------------------------- - Owner <br />By ------ -------------------- ---- Title ---------------- <br />- - - ----- ----------- <br />(If of er than owner) <br />R DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED 13Y -- -- - `---------------------------------------------------------------- ------------- DATE ------------ - �� �-�--��--�------� <br />BUILDING PERMIT ISSUED __/jP__P_k_(_Cj47JQN ... 66 _AJE ! R_6_Lf-_..6__._ J------------------ c�DATE ------------------------------------------- <br />ADDITIONAL COMMENTS -� _f 1_YkI I I ,& I r�` �f------------------------------------ ---- . <br />---------- ----------------------------------------- <br />--------------- --------------------------------------------------------------------------------------------------------------------------- <br />-------------------------------- <br />Final Inspection by: - Date `�% Y <br />------------------------------------------------------- ------ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 1-'68 Rev. 5M <br />