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9 <br /> nFOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> • Permit No. -.7- <br /> ..................... (Complete in Triplicate) <br /> ..................................................... p f/ <br /> This Permit Expires 1 Year From Date issued <br /> Date issued ......J........... <br /> Application is hereby made to the San Joaquin Local Health District for a per 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: l <br /> JOB ADDRESS/LOCATION ..... /�.7�,... Grj.�... r � -� ... --•• ai91�..CEN5U5 TRACT .......................... <br /> 7l<� -......... ..............................:...-------......-----Phone __ .:� � ...-- <br /> Owner's Name �fF�s��R <br /> ........... .. •---•- <br /> Address S 11� .... City ' <br /> ._.....License # . Phone <br /> Contractor's Name ._!'__ /frt�- ....------- ....................... ........ ..................... � <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial '❑Trailer Court ❑ <br /> Motel 0.Other ..................................-------— <br /> Number of living units.../...... Number of bedrooms - ..... <br /> Garbage Grinder s-• Lot Size ..-..._ - .�- - •c-- <br /> Water Supply: Public System and name ------------•- -------------------------................._.................................. .................Private <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ .Peat❑ Sandy Loam ❑ Clay 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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 204 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK[ j S 057-;1vG Size...................r-------------- ........... Liquid Depth ......................... <br /> Capacity ---•---------------- Type ------------ ....... Material...................... No. Compartments .................... S <br /> Distance to nearest: Well ---------------- ---------------Foundation ...................... Prop. Line .................. 6 <br /> LEACHING LINE No. of Lines ..... ................. Length of each line.----.-- Total Length .---7S-- .....__------ <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ....................................... <br /> ISTi G Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT r Depth .................... Diameter ................ Number ---._............... ....... Rock Filled Yes ❑ . . No �,.• <br /> Water Table Depth ................................................Rock Size ................................ 1. <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... 0 <br /> REPAIR/ADDITION(Prev. Sanitation Permit+# ............................................ Dote ..................................) .15 <br /> Septi <br /> - <br /> Septic Tank (Specify Requirements) _.... ------------ ! f <br /> ............... <br /> ..__•- . . - <br /> � - ......alDisposal Field (Specify Requirements) G' <br /> to <br /> 1 <br /> -----------------------------•------•--------------- ....................----------------..._.......................... ...........................----------------........................ <br /> .1n <br /> -------------....------....- ------ ------------........--------------------------------------------- ---............................................................................................ <br /> (Draw existing and required addition on reverse side) <br /> 'r <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 th performance of the k for which this permit is issued, I shall not employ any person in such manner <br /> a: to become ie orkmaCo ensation law of Ca ifornia." <br /> Signed..-- --_.. . .-----•r ........... . .. ...• Owner_. <br /> ................. Title .......----------------- ............................................. <br /> (if other than owner) - <br /> F DEPARTM2E USE ONLY / <br /> APPLICATION ACCEPTED BY ..... ........ ------............... -....... --...---•-----•----------•----.. DATE h/•• �j�=.- ------ <br /> BUILDINGPERMIT ISSUED .------•. -------••----------------- ----•---••---•---- ---•-••---••-•••......--••------.......I...---DATE ...----------•-•--.......I.---..........._. <br /> ADDITIONALCOMMENTS .............•-----.... ................................... •---••-------------• ............................................................................. <br /> .............................-.........................._•.............. •--•-•-•-------------......--- ...,.. <br /> ..................................................................... ....................... .• --• ............................................................ _ <br /> .......................................... •----- ------ ._........ .... • ...................................................... <br /> Final inspection by: ....................................................--Date ............... ........--------- <br /> ..... <br /> SAN JOAQUIN OCAL HEALTH DISTRICT <br /> E. H'.13 24 1-'68 Rev. 5M - - — 7/72 3 M <br />