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FOR-OFFICE USE: "i'" <br /> �Z-'�AOLICATION FOR SANITATION �!ERMIT <br /> w <br /> -------------------- - �8. <br /> Permit No. <br /> �� , <br /> � (Complete,in Triplicate) <br /> ------------------------------- ----- ------------ <br /> This Permit Expires 1 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 /> JOB ADDRESS/LOC N . IZ - A-.-- '`- -- --- -? CENSUS TRACT <br /> Owner's Name --------------- -__ - �; h--------------------_Phone,.__ <br /> OF <br /> Address ------------- _ _ -------- City t -- ---- ---------------------------------------------- <br /> Contractor's Name ------- --- ---- ----s- ----- -----_ l.x .License # --�------------------- Phone Y4-67_!_O— ---- <br /> - - [ � til . <br /> Installation will serve: `Residence oApartment House❑ Commercial ❑Trailer Court ❑ <br /> �\ <br /> Motel E]Other -------------------------------------------- <br /> Number <br /> ---- --- --Number of living units:_._- Number of bedtooms _________Garbage Grinder -rll-D__-- Lot Sze 60_____________F______________ <br /> Water Supply: Public System and name ------------------------------------ --------- --- - '_ <br /> ----------------- <br /> ❑ x. ` <br /> Private <br /> Character of soil to a depth of 3;feet: Sand'❑ Silt❑ Clay ❑ Peat❑Sandy Loam ❑ Clay Loam :❑ J+ <br /> Hardpan ❑ Adobe Fill Material -------__\•__�y type J <br /> If yes, t e `--------------------- s <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: INO septic flank or seepage pit permitted if publi sewer is available wiTF1�rz 200 feet,) <br /> // <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ j Size-- -- ----- - ----------\---- Licf0i` depth ------ _____________ <br /> p y yp �__ Material_ V�Q�TF Na. Compartments .................:.... <br /> I <br /> Distance to nearest: Well __________�-_---�-_----�-__----�-:FoundatFon �A40, Prop.PYop. Line .--------..-�..._.... - <br /> LEACHING LINE No. of Lines --------- ------------- Len th of each line-----._ _7 3_ Total\i.�efigth -----J,�__........ <br /> ._... <br /> 'D' Box ----1 _ Type Filter Material -Pac&-------Depth' Filter_Materials_!�__ _/----------- <br /> _�._...... <br /> Distance to nearest: Well ------------------------ Foundation ----/I6--_ ----- Property Line _ter_________________ # <br /> SEEPAGE PIT [ ] II Depth --A�----_---- 1Diameter -�V_........ Number ------- � ------------- Rock Filled-4 Yes No <br /> Water Table-Depth ------------------------------------------------Rock Siz -.---- <br /> Distance to nearest: Well ________________________________________Found tion ----- 0---04---- Prop. Line __ ___ _________ * <br /> i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _________ _________________________________ Date __________________________________ <br /> Septic Tank (Specify Requirements)------ - -------- I <br /> • l } <br /> , ----------------------- ---------------------------------------------•.------------------------ <br /> ... <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------. ------------------------------ ------------ <br /> 1! <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 doneiin accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules,and"Regula"�tio of`the.San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the foliowi g: 4� <br /> "I certify that in the performance'of the work for which this permit is issued, shall no employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." ) <br /> Z�A <br /> ` ---------- - -3---:------------ IV <br /> Signed ------------------------ ----------- <br /> -- OWner <br /> BY00000 <br /> p <br /> --------- ------ w --------------------------------------- -Title ------�•_ <br /> ( fo <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED DATE :_� - � <br /> - - ----- <br /> BUILDING <br /> PERMIT ISSUED ------ -------------------------------- -------------------------------=--------------DATE ------------- ----------------------------- <br /> f <br /> ADDITIONAL COMMENTS -------``-'=-'-'---��--�------------------------- -- ---•-- if <br /> - - -- ------------------------------------------------------------------------------------------ <br /> --------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------- <br /> Final,Inspection by: -� •` Date div'-� <br /> ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'69 Rev. 5M <br />