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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> �, (6.--- " 13 fCompfete in Triplicate) Permit N . ., -_- -„----•, <br /> o - 71 <br /> -!l <br /> .......-................................... This Permit Expires f 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 /> 94G 6 , <br /> JOB ADDRESS/LOCATION ----- .. .__ ! !e �.-, --. �pENSUS TRACT _-. <br /> Owner's N HCl-'� `--- s i-'-/!1..--------•... ------- ------..Phone .----------------------- <br /> F— <br /> -----....... <br /> .---- '-'- i <br /> I <br /> Address - '. ., a� -- - - ...-.-.-..City -,Z1Svf ..-....t� <br /> r p <br /> Contractor's Name-. .-c]',7 .- <br /> -----'---------------- ---- ........----------License#17-7.;$-Si3 Phone -4`_........2 7.G <br /> ------------- <br /> Installation will serve: Residence Apartment House C] Commercial)]Trailer Court 0 <br /> Motel C]Other..------.............. - , <br /> Number of living units:---1.-.--. Number of bedrooms _ -......Garbage Grinder ..... Lot Size : ...........:. <br /> -- <br /> Water Supply: Public System and name ..........................................--w ,-•-----,Private)z}•' <br /> Character of soil to a depth of 3 feed-,__Sarrd�_Silt Clay_j$ Peat p Sandy Loam Q ' Clay Loom C] <br /> Hardpan ❑ Adobe o 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,`ank or seepage pit permitted if public sewer is available within 200 feet,) ..� <br /> PACKAGE TREATMENT [`r aEP11 <br /> TIC TANK t ] Size..--Sp..�.?�,..y9.xS--r.---, Liquid Depth ---�.-'-------------- <br /> ' Capacity Type RsrrMaterial.,>(.177t:+ No- Compartments ........... <br /> Distance to nearest: Well -.....?v-..-"................=: .Foundation:7D- ....-..-.. Prop. line .s..r....-......- 4 <br /> LEACHING LINEi <br /> [r]'� No. of Lines -..Z................ Length ch line- ..... Total length <br /> ................r <br /> 'D' Box -. - Type Filter Material ----------Depth Filter Material _-.--._. „-......,..- <br /> Distance to'nearest: Well .r00---�---• -.- Foundation �.I�--:;"............. Property Line. 3..._-............... <br /> +� <br /> SEEPAGE PIT [a-- Depth ...%t.� �,-„-_ Diameter .-.--r - Number ... .� ` f, -- Rock Filled Yes � No <br /> Water Table Depth . - -......-------------Rock Size ....a--r:-....-'-........... <br /> f� Distance to Nearest: Well ...-.--.__.-•------,-r..,....,.........Foundation ................... Prop. Line ..................... <br /> REPAIVADDITION(Prev. Sanitation Permit# ...............-...^tz -•,-„ .,----...,,_ Date ...................i, k. <br /> Septic <br /> k <br /> Se tic Tank (Specify Requirements <br /> ) -- ---'----•--- --_-..---._----------------------......-- ------—---------------- <br /> Disposal Field (Specify Requirements) ...........n.: c <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, an'd Rules and Regulations of the San Joaquin Local Health District. Home owner at 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 ........ . ..... - ....- .-.-... f Owner <br /> By -------------•• >s <br /> ...-.-.: - -._ - - ' Title ................. ................{I other than owner) ! , <br /> FOR DEPARTMENT USE ONLY �y I <br /> APPLICATION ACCEPTED BY.--.., -r°-- --,.. -- .11..L'tQ:_an.../--� ................._. DATE ---- --r.._St7.... .....- <br /> BUILDING PERMIT ISSUED.............:! DATE .. -.......- <br /> ADDITIONAL COMMENTS ...- � <br /> J - - .....--'-- -- .. - -.....: <br /> .......................... <br /> �-�...,---. <br /> - ----------- ----------------------------------------------------------------- ------ ' - ------_---------------- <br /> -------------- <br /> // .-' - <br /> inal Inspection by: :.. `-e �e--,.t. ' u - <br /> � � -' -...........................------_-------------Date .-. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT i <br /> E. H. 9 1-'68 Rev. 5M <br /> f <br />