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E <br /> FOR OFFICE USE: <br /> PPLICATION FOR SANITATION Pff,"T <br /> - <br /> ------------------•----------------- <br /> (Complete in Triplicate) Permit No. 7.7-- --_____- <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 'th County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION ._. /.._-__-------_ ___ <br /> _ - ---- ------------------- - <br /> ----CENSUS TRACT ................. . . .... <br /> Owner's Name ------- ----------- - ----------- -- ----- --- •-•-- -- Phone -----------------------.------------ <br /> Address ------------ �------- ------------- City --- -------------------------------------- <br /> Contractor's <br /> r <br /> r ---------•--.._.. <br /> Contractor's ._.. <br /> Name -------- -- ----_-- - --- - -License # Phone ------------------------------ <br /> Installation will serve: Residence ❑ Ap rtment House❑ Commercial Trailer Court ',❑ <br /> Motel ❑ Other - -�e --- <br /> Number <br /> _Number of living units: _-- Number of bedrooms ___---___Garbage Grinder _<f_-: Lot Size ___________________________________________ <br /> Water Supply: Public System and name ____________ (7� ¢ , _•--Private ❑ <br /> T` .- -"-----�f- ---------------------- ----- <br /> Character of soil to a depth of 3 feet: Sand d Silt C] Clay .❑' Peat❑ Sandy Loam Clay Loam <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 see ge pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ SEPTIC TANK' Size_5_-- 4� --- Liquid Depth _l-Z_----____-_ <br /> Capacity _ -L_e_ ,__ Type __ Material ZNo. Compartments -- ............. <br /> r f <br /> I ----- ' Foundation a Prop. Line ...-S <br /> / i / <br /> LEACHING LINE [1� No. of Lines nearest------ Length of each line____-___61_d____.-_-,__ Total Length :____l0_4?_--------------- <br /> 'D' <br /> _--_-:__•. _'D' Box ---'�'_._._ Type Filter Material ___ _Depth Filter Material _/I----------------------- <br /> �77 G <br /> Distance to nearest: Well -----1_0.d--r_._-_. Foundation -------1__Ej_'______-_ Property Line, -__5........_________ <br /> [X Depth -----1- ---------- ter�3\_X.11_ Number ----------1--------------- Rock Filled Yes ] No <br /> -DistWater Table Depth ------------------cj�v--- ___________._.._-_-Rock Size ____ -------------- <br /> Distance <br /> ance to nearest: Well ----------1-7-9_------- ...........Foundation ____I_a---------- Prop. Line ----.................. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# __----------------------_------------------- Date .-.____.______._________-•--_-•-_-) <br /> SepticTank (Specify Requirements) ---------------=------------------------------------------------------------------ -----------------------------,­------------------ <br /> Disposal <br /> -------- -----------------,,.------------------ <br /> Disposal Field (Specify Requirements) ----------- ------------------------------------------------------•-----------------•--- -------- <br /> --------------------------------------------------------------=------------------------------------------------------------------------------------------------------------------------------------------- <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 /> "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Wor pn's Compensation laws of California." <br /> Signed ------------------------------- ---=-- -_-- ---=-- --_------ Owner . <br /> By ---------------------------------------- ---- Title - - - ------------------------------------------- <br /> (If other than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ._ _ . _ . _____. DATE _.. _"1 s3_"_._2_ "'_________ <br /> - -------------- ----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED ----------------------- --------------DATE ..--------------___--.---_._ -- <br /> ADDITIONALCOMMENTS -------------------------------------------------------------..---------- --------------------------------------------------------- ------------ • ---------- <br /> -----------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ <br /> ----------------------------------- -------------------------------------------------------------------------------------- ---- --------------------------------------------------- <br /> ---- ---- --- <br /> _------ <br /> Final Inspection by: ------ -------------------------------- ---- -----------Date` -- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F. H 9 1-'AR RP., 1;AA <br />