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K-M cmmc;t ubt: <br /> APPLICATION FOR SANITATION PEr'MIT 7.7 s-37 <br /> - ------------ - <br /> \/ (Complete in Triplicate) Permit No. ------- -- <br /> -•---- - <br /> ---------------------_. -----_._......___------- This PermitExpireslYwrFremDatelssued <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 Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..--..._J'/.. 7_......U( -- /7 ---- / W-----. - <br /> CENSUS TRACT .------------.------ --- <br /> n�t / <br /> Owner's Name - - J-O-C© a D S--Q-IZN 8 .... .... --•--------- ------ - ----Phone -------------------------------- <br /> Address .. -------- -- ----------- 5 Q "t �---------- ---------------------- ------------ City ---------------- --------------------------------------------- _---- <br /> Contractor's Name -----------------------,S- I-----------------------------------------License # ---------------- --.... Phone <br /> Installation will serve: Residence NrApartment House-E] Commercial❑Trailer Court 0 <br /> Motel ❑Other ---------------------------_________________ <br /> Number of living units:-----I.... Number of bedrooms ____ ___ Garbage Grinder .__. ----- Lot Size --------I? _Q^r5.....__. <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 0 <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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size------------------------.____.______- Liquid Depth .__ <br /> Capacity <br /> --- Type .................... Material--------------- --- Na. Compartments ......... 6 <br /> Distance to nearest: Well .-----------------------------------Foundation _-------------------- Prop. Line ---------------------- oO <br /> LEACHING LINE [ ] No. of Lines ------- ---------------- Length of each line--------------------- ------ Tota[ Length __. -----................. <br /> 'D' Box ------------ Type Filter Material -------------------Depth Filter Material -------------.-- .................. <br /> Distance to nearest: Well ------..------ --------- Foundation ------------------------ Property Line ................. <br /> SEEPAGE PIT [ ] Depth ---___ ---------- Diameter --------------- Number ----------- --------------- Rock Filled Yes ❑ No ❑ <br /> WaterTable Depth -------------------___----_-------------.-Rock Size ------------------------ ------- <br /> JC <br /> Distance to nearest: Well ------._.-.-..._....._._._.____._.Foundation -------------------- Prop. Line ... <br /> REPAIR/ADDITION[Prev. Sanitation Permit# ..........---------------------------------- Date .___._._._____._.___.______._._._) D <br /> SepticTank (Specify Requirements) - --------------------------- ------------------------------------------------ .._.-.._.-. -------------------------- �. <br /> Disposal Fi Id (Specify Requirements) _ _._.._.__ .__ ... ........................................_. - <br /> " - ---------..C'Xia-. . - --- --- G <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 becom u ct to Workman's Compensation laws of California." <br /> Signed ------------------- Owner <br /> I <br /> By ----......- - ------------------------------------- -- ------------- ------------------- Title ...-- ---------- ---- - ----- ----------------------- <br /> (If other than owner) <br /> DEP RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- - - - - ------ DATE ......... .......... <br /> BUILDING PERMIT ISSUED ------ ---- - - - ------DATE ---------- ---- -- - - ---------- <br /> ADDITIONAL COMMENTS __ <br /> --'-- '—<'n"-- - - --iksu` a-'�.{�"..----------------------------------------------- ------------ <br /> - --- <br /> -------------------------------- ------- ------ -- ----- -------------------------------------- ----------- <br /> .-----------I ..... <br /> FinalInspection by: ----- - - - - ----------------------------------.---------- -----------.Date ------•. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />