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-OR Oi FICE USE: <br /> ,PPLICATION FOR SANITATION PE( r <br /> .............. ------ --...- - ---- -------- , <br /> (Complete in Triplicate) Permit No, I- .-`i✓ ..- <br /> ....... .................. ......... <br /> -.-...............__......................_.__-- This Permit Expires 1 Year From Date Issued <br /> 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 Qrdkance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .• CENSUS TRACT .J_V-7 <br /> / .............. <br /> Owner's Name ..._} qtr .^ :3 � `' �l� rz --� ------------------------ --- .....- ---� --� Phone - -... ........... <br /> Address <br /> ------------------ ------------------------- City .../.J ..? -- ---- - ---------- --- ---...--------.....-- <br /> Contractor's Name --------- - ----- -------------------------- --------------License # ...... ---- Phone <br /> Installation will serve:- Residence El Apartment House Commercial ❑Trailer Celt , ] <br /> Motel ❑Other ----------------- <br /> Number <br /> ------ --------Number of fing units:_f ....... Number of bedrooms -3--------Garbage Grinder ..... Lot Size - ' <br /> ................ -------------- <br /> Water Supply:�Public System and name ----------------- --- - --.....Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay ❑ Peat D Sandy Loam ❑ Clay Loam gJ <br /> Hardpan JU 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 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK:R1 Size--.-.yi�- /9 t_____-.-..------=•___ ____ _ Liquid Depth .Y_`------------------- <br /> Capacity -e e - -- T e .r <br /> YP �--`-=`'---- - Material.(�"-'�. -- ...- No. Compartments .�--••------------• N <br /> Distance to nearest: Well . 7471P -- ..--_.---.--.----Foundation .--.--..__..___ Prop. Line . r.�----..-.-_--._ <br /> LEACHING LINE Q4 No. of Lines _ . <br /> --- ----- -- Length of each line.__.SF?'_ ._ . Total Length ................ <br /> 'D' Box ...... .. - Type Filter Material --------------------Depth Filter Material .____...__...-..._.._____.---------------.- <br /> Distance to nearest: Well Foundation .. Property Line .-..-..__ <br /> SEEPAGE PIT ] Depth __ S�- __..._ Diameter 3;----------- Number - ;. ................. ... Rock Filled Yes No <br /> Water Table Depth --------------------------Rock Size -/-y---.. ''... <br /> Distance to nearest: Well _yp..--------------------------Foundation ..1P_-__...._... Prop. Line I.-_...._.---- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- --------- ---- ................... Date ....---------.--.---.-_-__--------) <br /> Septic Tank (Specify Requirements) -- -- - -- ---- ---- -------------- -------------- ------------------------------------_ --- ---- ------- <br /> Disposal <br /> -Disposal Field (Specify Requirements) - ------------------------------------------------- ------------------------- ---- --------------- ............ <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, 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 for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's,)Compensatialaws of California." <br /> Signed ,+�4r�t. >' x. --------- ----------- Owner <br /> By . ....... .......... - ------------- ----------- --. Title ........ ..._..._........... <br /> (I€ other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY G'2�*1c* DATE Y_1'.�.'.�� <br /> BUILDING PERMIT ISSUED ............... .. ...__----------- --...... ......DATE .......... <br /> ADDITIONAL COMMENTS ......... .. <br /> ..... . .. r ... <br /> .. . - ----- ----- --- - ----- . <br /> Final Inspection by: c'1 ]:�_.,.1! Date . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F. hi*. 9 1-'68 Rev. 5M <br />