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FOR OFFICE USE: PLICATION FOR SANITATION PERiVr <br /> ----------------------------------------------------- Permit No:`7_,_-3_7.x <br /> (Complete in Triplicate) . <br /> ------------------••-•------- --------------- his PermiExpires.] Year,From a e Issued <br /> sued !� <br /> tel 3 7 L <br /> Application is hgreby made to the San.i aquin-Local l-lealth 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 --S___—---- - -- .- -- ----- -/u--CENSUS TRACT ....:.. .. ............ <br /> Owner's Name ----�J--------------------- --------------------Phone <br /> ---- ----- - - - -- <br /> Address �j= ''`��------A ........ Cify - --- -•-------------------------------------•------ <br /> Contractor's Name =----- ---- ------------ ---------License Phone .-_-------------............ <br /> Installation will serve: 'Residence ❑Apartment House] Commercial . Trailer Court ❑ <br /> ` <br /> Motel EJ Other----- -��___ _ �—W��- <br /> Number of living units:--__ _______ Number of bedrooms ._ g ' J <br /> �...Garba e Grinder ------------ Lot Size ---- ......... <br /> Supply: Public System and name ------------------------------------------------------------------.._ -•----------------------Private <br /> Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam C❑ Clay Loam <br /> Hardpan Adobe'❑ Fill Material ------------ If yes,type ---------------------------- <br /> L <br /> oh <br /> (Plot plan, showing size of 'lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) c0 <br /> NEWINSTALLATION-, ,(No septic.tank or seepage pit permitted i ubllc sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( I SEPTIC TANK Size-_,�?'—1---�_��__5.--�__. Liquid Depth ____V------------------- <br /> Capacity J\�ttP_ ,__ TYpe Material---�`� --�.-.. No. Compartments _.: .... ........... <br /> Distance to nearest. Well ; -_-- d_�_________________Foundation ---L__0__°______.._ Prop. Line __S'____-_.____-__ <br /> LEACHING LINE [ No. of Lines --__--__l___--___-_`- Length ofm each line_______ �_a_ _-�_._._ Total Length .I.a..to...�....__._ <br /> D' Box _r--------- Type Filter Material . '�-- ____--,Depth Filter Material al_ ---------- ,--..:---- <br /> Distance to nearest: Well --__�$_f___._.....__ Foundation ________1t....__..__ Property Line. -------------------­-- <br /> ----- <br /> __--~_--_.-.- -: -- <br /> SEEPAGE PIT Depth � 1 _ Diameter ----�3. . Number ________ _ Rock Filled Yes � No <br /> [' p ------ -- <br /> Water Table Depth -----------2V_,---------I----------- ----Rock Size )e.,?.---... <br /> Distance to nearest: Well --------- --------------------Foundation ------- Prop. Line .. ............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit T# ........------------------------------------- Date -------------.--------------------) <br /> SepticTank {Specify Requirements) ------------------------------------------------•-----------------------------------------------------•------------------------------------- <br /> DisposalField (Specify Requirements) ------------------------------------------------------------•-------------------------------------------------------- ----•--------- <br /> E <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 Compensation laws of California." <br /> Signed ------------------------------------------------- Owner <br /> By ---------------------------- ---------------------------- <br /> ---------------- Title <br /> ---------I--------------------------••--- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY . <br /> APPLICATION ACCEPTED BY 1,.. ----------------------------------------------------- DATE _. = ---------------- <br /> BUILDING PERMIT ISSUED ---------- ti-- DATE -------------•- <br /> ------ <br /> ----- <br /> ADDITIONAL COMMENTS e = ------------ ----------------------------------------- -------------------------•------------ ---------- <br /> -------- •- <br /> ---------------------------------------- --------------------------------------------------------------•-------..._.----•------------------------------•--- <br /> ------------------------------ --- <br /> - - -- ----------- <br /> - - ------- <br /> -- r p-�---- W-- <br /> Final Inspection by: ------ - - G-.----•------------- --------••----------•---------------------------------------.Date ------------------------------ ------------- <br /> SAN <br /> - --------------- •--------------•------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />