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AFr }ATION FOR SANITATION PERMr,, t d <br /> ' Permit N' (Complete in Triplicate) -' o: -- -�---q----•-- - <br /> ------------------------------------ <br /> ------------------------------------------------ ThisPennit Expires 1 Year From Data Issued <br /> Date Issued .9."_z._9__?/ <br /> Application is hereby made to the San Joaquin focal 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/LOCATI N /-•fir ------� - CENSUS TRACT - <br /> Owner`s Name -�---------i- ----•--- -•- <br /> •---------_--�------------ - -•---- Phone ---------=-- <br /> Address --- - : C------------- .. ----------------�------- <br /> - <br /> _ <br /> Contractor`s Name ..__ . __ ,--. r a icense #AV..:3Phone ---------------------•----•--- <br /> fnstallation will serve: Residents[(Apartment House C] Commercial❑Trailer Court 0 <br /> Motel ❑Other- --------------------------------------- <br /> Number of living units:----./---- Number of bedrooms __:.__.,___Garbage Grinder ------------- Lot Size _____________________ <br /> Water Supply: Public System and name --------------------------------- Private <br /> - -- ----------------------•-------------•------ ----.---- <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat[} Sandy Loam T( 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 /> NEIN INSTALLATION: (No septic tank or seepage pit permitted public sewer is available within 200 feet,} <br /> l N <br /> PACKAGE TREATMENT } ] SEPTIC ANKT Size- - -------- Liquid Liquid Depth ---�-----....... <br /> ------ G <br /> Capacity �'P TYPek�s -�-- Material.A___ No. Com G <br /> partm6nts -- -------=-- <br /> Distance to nearest- We ilo <br /> - ------ --_--Foundation _10 Prop. Line ----- :.,. <br /> I:EACHi <br /> NG LINE 14--"'No. of Lines ------rr_�----- --_.-_ Length of each <br /> _ line.-.---- <br /> ----------- Total ---�-- <br /> ----- <br /> 'D' I <br /> Sox .- ___-•- Type Filter Material ... ._ e_.__-_Depth Filter Materia( ....___ly Al-------- <br /> Distance t nearest: Well .____ - Foundation " <br /> � '-•,--------- Property Line .._��'_. <br /> SEEPAGE PIT € Depth ___-�-5_!-• Diameter _ _.��.-- Number .--------__ L`/ <br /> .. ..— --.-____-- flock Filled Yes No ,❑ . <br /> Water Table Depth -------- -- - <br /> --------Rock Size -� <br /> Distance to nearest: Well ----------/4_D�_________ _______Foundation --__1_� } S <br /> - . . ..- - Prop. Line---------------------- <br /> REP�4iR/ADDITION Ifrev. Sanitation Permit# ----------------------------•-----.-------;: Date ------------------------------•--1 <br /> ;'.Septic Tank (Specify Requirements) --------•------------------------- - <br /> -------------------------------------------------.-•----------------------- - <br /> Disposal Field (Speri . q <br /> fy Requirements) _... - . <br /> _.---•------------••------------- ---------------------- ------•--- ---------------- -- - <br /> ----------------------------- <br /> (Draw existin d <br /> g anrequired addition on reverse side) . <br /> I.fiereby certify that I have prepared this application and that the work will be coned-in accoidance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regufations'of the Son Joaquin Local Heafth District. Horne owner or licen- <br /> sed agents signature certifies the following: <br /> Certify that in the performance of the work for which this permit is issued I shall not em <br /> os' to + ploy any person. in such manner <br /> to become subject to W aa's Compensation laws of California" <br /> i Oned -------------------- ----- ------ <br /> Owner <br /> iiy._.-----•---- - ---- '---V <br /> - title <br /> ---------------- -•--------- <br /> (If other tkowneri ` <br /> FOR DEPARTMENT USE ONLY u <br /> r <br /> APPLICATION ACCEPTED 8Y - - ------ DATE <br /> ITIONAL COMMENTS BUILDING PERMIT ISSUED --------------•------- _ . _ ------------------. ____-.-------DATE ----------- -------------I --_- __ <br /> ---------------------•--- ------------------------- -------------------------------------------- ----------- ........_. _--------------------------- `-----• --•----I-•------- ----------•---•------ - <br /> Fnat Inspection by: - ------------------- ----------------------- Dare r_,r� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT / <br /> E.H. 9 1-'68 Rev. 5M !� <br />