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F <br /> .tR 0"'Ci USE: APPLICATION FOR SANITATION PERMIT <br /> 0 , _ �A; -70 - 0 <br /> - ----------­-­------------------- (Complete in Triplicate) Permit No. ------------- <br /> -------------------------------------•--------y.... Date Issued <br /> This Permit Expires I Year From Date Issued <br /> --------------------------------------I------- ...... <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. 50 and existing Rules and Regulations; <br /> JOB ADDRESS/LOCATION Ao�._CENSUS TRACT .......................... <br /> Owner's Name .................. -- ------------ •- --- .........Z.Phone-------------------------*----------- <br /> it� __.. . ........... <br /> -phone Address ........... ---------Mf M ------------ <br /> -------- -- ---------------- <br /> ........... .. <br /> Contractor's Name ------------------------- --.-..----.License <br /> 00 <br /> Installation will serve-, Reiidencepf Apartment House C]Commercialo. Trollet Court C1 <br /> " I Motel [-)Other-------------------------------------------- <br /> Number of living units:---/.---- Number of bedrooms __......Garbage Grinder Algo,- Lot Size ,g---_--••-- <br /> I --- ------------------------Private <br /> Water Supply- Public System and name --------------------------------------------------------- --- -- <br /> ........... <br /> Character of soil to a depth of 3 feet I- Sand 0 ❑Si It 0 Clay C] Peat❑0 Sandy Loom [:] Clay-Loam <br /> .]Hordpan ❑ Adobe 1[] Fill Material ............ if yes,— ---------------_ ---------- <br /> (Rl'ot plan, showing size of lot, location of system in relation to,wells, buildings, etc. must be placed.on reverse side.) <br /> h <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 -------------------- N%J <br /> Capacity Type .................... Material-- ---•-------------- No. Compartments ----.................. <br /> - - <br /> Distance to nearest. Well ----------------------_-----------Foundation ---------------------- Prop. Line --_-------- <br /> -------- <br /> LEACHING LINE No. of Lines ------------------------ Length of each line---------_---------------- Total Length ------------_------_....._. <br /> 'D' Box ....I........ Type Filter Material ....................Depth Filter Material ....--------------------------­- <br /> I <br /> Distance to nearest: Well -------------------_--- Foundation ._...--....-----------•- Property Line. ------------ - <br /> C3 <br /> SEEPAGE PIT Depth -----J.............. Diameter ................ Number ------------------- -------- Rock Filled Yes 0 No <br /> Water Table Depth •---------•-• --------------- <br /> ---------------•• -Rock Size _--------_----------------- <br /> Distance to nearest: Well -----------------------------------7....Foundation .................... Prop. Line <br /> REPAIR/ADDffl0 (Prev. Sanitation I Permit# _-------------------------------------------Date'------------------------•--------•1 <br /> t I .,_- <br /> -- <br /> Septic Tank (Specify Requirements) ___.:............ ---- ---------­---7............. <br /> /------------------------- ------- <br /> ----------_------- <br /> Disposal Field ASpecify Requirern,rwpr w� <br /> ----------- .......................... --__------- ------------ --------------------•-------------------•---...w.-------••----•-••--..._ <br /> --- -------- ------------------------------------I............__----------------_--------- ---------------­------- ...................­_____....... <br /> 1'{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 Son Joaquin <br /> County Ordinances, State Laws, and Rules and -Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the fillowing- <br /> "I certify that in the performance ;f the weirk 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 /> Yitle ... ... .... .........................•------ ......... ............... <br /> --------_- <br /> a er t an owner) <br /> F FOR DEPARTMENT USE ONLY <br /> BY _eA____Jy.A.kP!Ax-J L------------------_--­------------------------- DATE,-- .r..------------- ---------- ------- <br /> APPLICATION ACCEPTED .. . ___.0ATE ---------------- ------------------------ <br /> BUILDINGPERMIT ISSUED ....... ........................................................................ <br /> -------------- ------------------------- ---------:•••• ----------------- -------------------------- <br /> ADDITIONAL COMMENTS ------------! ­ ­ - <br /> ---------- - I--------------- - <br /> - <br /> ------------1.111----------------1-------------- ------------------------------------------------------------------------------------ -------=-----......_•••..-•-- .._....,........... <br /> .................. ---------�k......................:!�----------- --------- <br /> .....................................................................•-------.-"----•---•---•••••• ..... ........... <br /> �.F .... ................ ----------- ...... e. <br /> ------ <br /> ........................... <br /> Final Inspection ...... .......I......... <br /> Dot <br /> N - .- <br /> SAN.,AAQuIN LOCAL-HEALTH DIST�! - <br /> E. H. 4 1-'68 Rev. 5M. <br />