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- o <br /> ` FOR OFFICE USE: <br /> — APPLICATION FOR SANITATION PERMIT <br />................................................I........ Permit No. .9...... <br /> (Complete in Triplicate) <br /> _:..._.._........................................... <br /> Dote Issued l!�..:......... <br /> -•--••.-••............................................. This Permit Expires 1 Year From 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/LO TION ....L. . 79'1.._.._ _. ._....... .. _ .................... TRACT <br /> _�..__....s. .. .. ^Phone .................................... <br /> Owners Name .. . +-y� __.. . .. .............. ,-- - -. . <br /> Address _..1..7..- ..../.. !1 / Clty <br /> ------ <br /> Contractor`s Name ....... .... ... . ......�.. . .......... .:::...._..License # MA. r�... Phone .............................. <br /> Installation will serve: Residence Apartment House❑ Commercial []Trailer Court ] <br /> Motel ❑Other ..:..:..........:...................... <br /> Number of living units:_.._------ Number of bedrooms .4--:-.Garbage Grinder ............ Lot Size ........... .... .................\� <br /> Water Supply: Public System and name ....................................... -----_-------..___....................................................Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay C:] Peat❑ 5dndy Loam C] Gay Loam ❑ <br /> Hardpan Adobe (] Fill Material ....__- .... If yes,type ______________-__-____-- <br /> (Plot plan, showing size of,lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.) I V <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available_within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK t f Size.5__'X.1.P.....................*.._........ Liquid Depth . _..._:.............. <br /> Capacity .�_ fid_ A, Type Material._..__ No. Compartments .02................ <br /> / Distance to near st: Well ._......... Q._�..1 '...----Foundation ..._1 ..____--__ Prop. Line ..�'r. ............... <br /> f _,. --_.. .. . Length of each line------- 4 - Length -- <br /> ' l <br /> LEACHING LINE No. of Lines .....-_ •--- Total <br /> D' Box ...-�-- Type Filter Material S Dbpth'Filter Material ...A?_ _•............................. <br /> --• ----- <br /> Distance to-nearest: Well ._ A_......... Foundation ..._/�-.._...-__.... Property Line ....�"�-..1........... <br /> SEEPAGE PIT {1� Depth --a2��/_.:.. Diameter _.` !Z.Fy... Number __._...-3..:............. .Rock Filled Yes [ No (] <br /> Water Table Depth ................Q..._.......................Rock Size ........ <br />' Distance to nearest: Well ..............I ................Foundation ..__---------- Prop. Line . .............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date -------...--_--------- _...... <br /> Septic Tank (Specify Requirements) -----------------------.........................----..........--------------------w.......-.............----------------................. <br /> . <br /> DisposalField (Specify Requirements( ------------------------................ --..--...------..._....._.._.. ............................................................... <br /> ------------------------------.............................-----------------._._.....-••--••--•--------...-•-•----............-•-•--••..._..._._...------ <br /> (Draw existing and required addition on reverse side) <br /> f 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. 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 /> Signed ..------------------- --------- ------ ----- :.._... Owner <br /> BY _ �_ ? �" . Title <br /> ........:.:................... <br /> (If other than owner) <br /> _ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 3Y -•-•-----••-- ....... .............................. <br /> BUILDING PERMIT ISSUED / ff...:. DATE ...................•----.._..--=--._...--- <br /> ADDITIONAL COMMENTS ...;f/ /•-7.. ................ ..........._._........... <br /> .............................................. .............:-•---•-•-------..........------ ....---------•-----........... <br /> .....................•----••--•------. .... - - :........`--------- <br /> Final Inspection by: -. .............•... -...------._......----•-----•---•--•---..--------- --.......--••••.....Date ...�f.. .. ........... <br /> i <br /> SAN JOAQUIN LOCAL- HEALTHDISTRICTco <br /> vw <br /> z3 24 r 7/723M <br /> c �� � .tee o_._ eat <br />