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FOR-OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> - <br /> ------------- <br /> --------------- ------------------- (Complete in Triplicate) <br /> - - <br /> Permit No: --- <br /> ' <br /> ____ _________________________________________ <br /> -------------------------------- --------:-----------_-- This Permit Expires 7 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/LOCATION ._f` tvGr#�J_ _sau iii-----I'- -----4V_ie-_---Ta-----w '� _.94CENSUS TRACT -------------------------- <br /> Owner's <br /> ------------ ---------Owner's Name ....SI4!;F_�S:7 .fi` Lty Phone :�IZ :_ <br /> Addressw��C7NE2 ,.--------. City � <br /> Contractor's Name __.-C _-______•S cv_<ft- <br /> ......License # ZSI-��------ Phone <br /> Installation will serve: Residence ;R Apartment House'❑ Commercial :❑Trailer Court ;❑ <br /> Motel ❑Other ------•----------------------------- ------ f; <br /> Number of living units:....,------ Number of bedrooms _•-----Garbage Grinder -----7_ Lot Size ___Imo__ X____f-70____-_____. <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 toi wells, buildings, etc. must be placed on reverse side.)�Q I <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V <br /> PACKAGE TREATMENT { ] SEPTIC TANK•'{•]., Size------------------------------------------------ Liquid Depth: ---___-------------- <br /> Capacity -------------------1 Type -------------------- Material--- ----------------- No. Compartments ------ -------------_ <br /> Distance to nearest:!Well _______________`----_fc________---_Foundation ---------------------- Prop. Line --------------- ...... <br /> C, LEACHING LINE TA No. of Lines ------- �__________ Length of each line-------/00..... Total Length _i____1± -------.._.__r�' <br /> 14W 'D' Box ----!------ Type-1 Filter Material...$. - -64---__Depth. Filter Material _________________________ <br /> ' st: Well _----���____-----'Foundation. -_ ,-�-�---------- Property Line .---�-x____----_--- <br /> SEEPAGE PIT Depth 2,5 i 1 -� <br /> Qistance to near <br /> Diameter ___ .__. Number ._____.___ __--__ Rock Filled; Yes No <br /> p --- i <br /> J9.DD Water Table r Depth _A*--_------- t.---------t -=----------Rock Size ---- --- -- --•-- --- <br /> i KT } <br /> Distance to nearest:Well __'__/. �� `-"-_-'-----"foundation :____ '____}._ Prop.i Line _.___S.............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .--------=F ----------------------- Date ____._-______-__.__-_____________-} <br /> Septic Tank (Specify Requirements) °— '- `--- -" -- - { <br /> Field {Specify Requirements) J2�M'" r�' _V---- �XJ�ST/N `ST€�---- ----------------------------- <br /> Disposal <br /> { .?._.......... _ �- <br /> - �f1 m. i -___! _ ._--_�_______________ <br /> _____________ . - ___ <br /> ( fi r ' ` ------------------------- <br /> -- ------------- ----- . - ------------ <br /> {Draw eX g 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!, ith 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#forlwhilch this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Coimpensan'laws of California." <br /> Signed � ilt:[7 �5- : /L ' ------Owner <br /> ------------- ` <br /> BY ------------------------ Title ---------------- -- ------------------------------- --- ----------- <br /> } <br /> (If other than owner) f <br /> 4 FOR DEPARTMENT USE ONLY } {' <br /> APPLICATION ACCEPTED BY _._ .__ .. __ - r % - '-----. DATE ------- -- <br /> BUILDING PERMIT ISSUED -- = ----- --- ---`-"-•---------------------------k.---- �_DAT€ <br /> ADDITIONAL COMMENTS ` _ :, =` - - ------- ------------------- <br /> . ... r,, ° ' --------------- <br /> _.- <br /> `�----- ---- `�• ° f -- --- t <br /> r ' <br /> �- - _ <br /> ------ --------------------- ----- --`•' i <br /> Final Inspection by: _ r' } - --------{-------Date _�_( .- � } <br /> ' 1 <br /> USAN JOA UIN"LOCAL HEALTH�DISTRICT :r 'r <br /> E. H. 9 7-'68 Rev. 5M <br />