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FOR.OFf[CUSE; <br /> V-0 APPLICATION FOR SANITATION PERMIT <br /> Permit No� <br /> .....................-..................... (Complete In Triplicate) <br /> .............­.... ............................. Date Issued <br /> .............................................:........ This Permit Expires I Year From-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 pompliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRE:SS/LOCATION ...............CENSUS TRACT ......... <br /> Owner's�,Name ..7n YO-e----- -----...... ................................. .- ..........­.... Phone .---............................... <br /> AACk <br /> Address _10?........ ........... ........... City L '_r9re --------------------------------:........ <br /> --------_--_---.. ............................ <br /> Contractot'.s Nome'�:... ......... ..................... ._....License # Phone .. <br /> Installation will serve: Residence 1p Apartment House[] Commercial.oTrailer Court C1 <br /> Motel M Other ---------------------------- ........ <br /> Number of living. units------------- N umberof bedrooms _7�. ..Garbage Grinder Lot Size _......................................... <br /> r <br /> Water Supply: Public System and name 1...................._-----_-- ----------.....--.------•-----------•-----••.Private D <br /> CharadVr. so a dipthaf 3 feet: Sand E?� Si it C] Clay E] ..PediC] Sandy Loam E] Clay Loam 0 <br /> Hardpan E] Adobe,E] FlIIM6terIol ......_--- 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 septics tank d'r—seep.,qgq,pItperrn <br /> jjJpAjLpvb.1i sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANKt0: Size.... ... ------ ------------- ...... <br /> Liquid Depth .... ----_-----_-- <br /> ......... Material.... ............. No. <br /> copoElty------------- Type ... Compartments .....--•.............. <br /> ......... to_nArpst:. Well ....................................Foundation .........:...... Prop. Un6 ............. ........ <br /> LEACHING LINE No. of Lines ---i'!_.............. Length of ecrch IIni__..!.....................zz Total Length ............................. <br /> 'D' Box .... Type Filter Material . :.Depth Filter Material I........ .................................. <br /> to nearest: Well .................. ..... Fo"undat ...... <br /> -Distance'. i06&... ............... Property Line. .................. <br /> SEEPAGE PIT Depth .................... Diameter _............. Number ............... ............ Rock Filled Yes C3 No <br /> Water Table Depth ................--------------- <br /> ----•--`-----!Rock Size ..................... <br /> Fo�ndatlon ............. <br /> Distance to nearest. Well ------------__......­.............. .Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........................................... Date'_............................... <br /> I ............. .................... ........................... <br /> Septic Tank (Specify Requirements) ................... .-------- <br /> I A4 <br /> Disposal Field (Specify Requirements) •--__---- ------ - _- ------........;Z---_-----_ <br /> .................. ........ ..................../...... . ................................ .......... ................... <br /> ..................................................... <br /> '4 - \1 .................................. ............... ...................... ...... <br /> ............__........... ................. ..... ............... ..........�r__ 'I------------:' <br /> (Draw existing and requlie&6ddition on reverse side) <br /> � �V i <br /> I hereby terrify that I have prepI ared this application and-fliat the wori will be done In accordance with Son Joaquin <br /> County Ordinances, State Laws,qmcl Rules and Regulations of the San Jopcluin 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 il":5—pormit is isgued, I shall not employ any person In such manner <br /> as to <br /> _ii� bject to kman's ompensa a wo su - Ion I rwskof California." <br /> .I.... ............. . ............... <br /> Sig .. .................. Owner <br /> ...................................... <br /> 13Y 4le I.;................ .............. <br /> ............... ...... ----------------- - -- ----------- ..................... <br /> (if other than owner) <br /> FOR DEPARTMENT-USE ONLY <br /> APPLICATION ACCEPTED BY .... . ....... XAW�<......... DATE ................. <br /> _41------------------------------------ <br /> BUILDING PERMIT ISSUED ........ .................... ..........r--k........ ...........-'-•-----•--- <br /> ADDITIONAL <br /> ...I..............DATE .......................................... <br /> ADDITIONAL COMMENTS .... ---_--------------- ...................... ..................... ........ ------------_--- ......................... <br /> I <br /> ............... ........................... ............................... .................................... .................... ......... ------- ..................................... <br /> .. ................ ............. -­------- .............. ............ ........................... --------- ....... <br /> ................. ........ <br /> .................................. . ... .... ............................. ..... ................­..........­------ ...............-1....... <br /> .................Date <br /> Final Inspection by: ..... . ......................._............ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F H 9 1-'68 Rev. 5M <br />