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FOR OFFICE USE: <br /> r APPLICATION FOR SANITATION PERM <br /> ................... <br /> {Complete in Triplicato) Permit No. ......... t� <br /> .........................I.,........ <br /> This Permit Expires 1 Year From Date Issued DaIssued �...7r <br /> A lication is hereby made to the San Joaquin Local Health District for a <br /> pA y q permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance Na. 544 and existing Rules and Regulations: <br /> � � � :. <br /> JOB ADDRESS%LOCATIO ...... ......----- •.............CENSUS TRACT ..............::.:...:.... <br /> Owner's Name ..... ._. _.. ........... .• ,... -•----... ......... ................................... <br /> Address ......-.-! .1... _.. City <br /> ............................. <br /> Contractor's Name ..��� f�R.- .. __.." ...... - -t..license # .�. R.rV77 Phone <br /> Installation will serve: Residence Apartment House❑ Commercial []Trailer Court <br /> Motel ❑Other ._.......................................... <br /> t V Water Sv I Public System and name --- -- ------ ---------' _-.-L' �g _ Lot Size ...���._.-... 1.-_ .,...__...... _ t <br /> Private <br /> Number of living unit.,.:._. Number of bedrooms ---�-._Garbo Grinder . -• ❑ <br /> Character of soil`to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> 3� <br /> Hardpan ❑ Adobe ftr Fill MateNal ...... If Yes,type ........... ................ <br /> i (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 pitepermittod if public sewer is avoilable.within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK-[ ] � /f,�i� '----------------- <br /> ........................ Liquid Depth _._............-•---..... <br /> l Capacity ` Type -------------------- Material............. ---• No. Compartments ............-......... <br /> pDistance' to nearest: Well .................................Foundation ....-.----- ------ Prop. Line ...................... <br /> LEACHING LINT: No. of Lines . Length of ach line ....tom .�.....;>.._ Total length -------------- <br /> 'D' Box .. : - Type Filter Material _-Depth Filter Material ......... <br /> Distance to nearest: Well ...�-.4V�!�Foundation _ Q..l..--...._. Property line _.. ../._.._...___ <br /> SEEPAGE PIT ( Depth .%1;57.. ... Diameter 2J....... <br /> Number ---------------- Rock Filled Yes No C]' <br /> i Water Table Depth ..._. .: _.._ ._...._ :`..e.. <br /> ...._..Foundation r <br /> ----._. Rock Size _... <br /> Distance to nearest:iWell ..._ -:Gc1-�� _ p. <br /> -f 1�..-�------- Pro Line ----4-............ <br /> ••- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........ ................................... Date _..... -----........_-................. <br /> Septic Tank (Specify Requirements) ......_..... ......... ........................ <br /> Disposal Field (Specify Requirements) .-- ---------_--------- <br /> ........... ............ .. ....... �...............*..."q... ................... .....................................­­.........­­­....... <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 /> F County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homeowner 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 no 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 other than owner <br /> APP 1 OR DEPA TM T USE ONLY <br /> APPLICATION ACCEPTED BY ... .. G..... - DATE ��.-��7�� <br /> BUILDINGPERMIT ISSUED .......... ............. ... -..............................-----.---......- ------........DATE ---- ----•..---•----•-•----•--••..•-_.. <br /> ADDITIONAL COMMENTS ------------- ----------_----- ................... .---..... ........... <br /> c-t , <br /> . ............... ----------------------- -- --- ----------- ---------- ------------ <br /> - ----- .._..._..._..........:..-.. <br /> l <br /> --------------------------------- ...... --...... . <br /> --._,.._---------------------------------------------------.............. -� <br /> Final Inspection by: .. •• -------- ---- ..__Date _ � -l:. <br /> ....... <br /> 1 SAN.J.OAQUIN LOCAL,,H A0,44,-DIST RICT <br /> E. H. 13 z41-'68 Rev. 5M 7172 3 M <br />