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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ...... .........:.............................. t (Complete in Triplicate) <br /> -----................................................... This Permit Expires 1 Year From Date Issued Date Issued T-.r55..'.-4t. <br /> •_- <br /> ---------------------------------- <br /> • --..--.----.- <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 /> QOdrJ �/ ((]]t�..- :......:... - .... ..........CENSUS TRACT ....... ..... ....... <br /> JOB ADDRESS/LOCATION _ ._ a3E�. .,ZS..., <br /> n t� <br /> Owner's Name ---- <br /> ..................•--.----..__............... ..------- --------........Phone....--- --------....,-•---- <br /> Address --?'' 1 ... Rl4G`i_A351..._....................-•---....._....._City . ...... M� ............... ... ...... _......... <br /> Contractor's Name �ri>1J`... ........License# ----.--.... Phone 1 <br /> Installation will serve: Residence ETZpartment House❑ Commercial❑Trailer Court C] <br /> Motel ❑Other......... /� <br /> Number of living units:......_... Number of bedrooms ...../.....Garbage Grinder .. !�... Lot Size ......A . <br /> Water Supply: Public System and name .......................-...-----------....._. - ............-.--.........Private[}-- <br /> Character of soil to a depth of 3 feet: Sand r ''Silt❑ Clay ❑ Peat�andy Loam 0. Clay Loam 0 <br /> - Hardpan ❑ Atobe n 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,[ side.) _ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK t ] .Size....m...................­.......Im........1.. Liquid Depth ........---.........,.-- O� <br /> i Capatityi..-............... Typo ---------.....---- <br /> Material...................... No. Compartments ....... ............. S <br /> Distance to`nearest: Well .._------. ..........Foundation ...................... Prop. Line..........,_:.,..._. <br /> LEACHING LINE [ ] No, of Lines ........................ Length of each line..... ............._------- Total Length ............................ <br /> 'D' Box ............ Type Filter Material ,Depth Filter Material ............................................ <br /> ^--/mss - c. __^ —a ��. ..-.tea ^. a .-.. <br /> -� Distance to nearest: Well -.--------_--.....:.. Foundation ........................ Property Line,'".:..-.-....-.-.-.:....' <br /> SEEPAGE PIT Depth Diameter ............... Number .............----.---------- Rock Filled Yes ❑ No [] <br /> WaterTable Depth ............._-----......._...................Rock Size .............-------.....-•-- <br /> Distance to nearest: Well .. ............................. <br /> ...... <br /> Foundati Z Prop. Line .... ....... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................... Date ..........!.......................] <br /> Septic Tank (Specify Requirements) ............�.a� 2 T-] .. ......................__................._.. ....._................ <br /> Disposal Field (Specify Requirements) ..Lq.,--.. k... .................... ......................................... ................ �v <br /> - --'............ ........... ._... -........ . ............ ..-.................- ...-:.-_------- - <br /> .,.......... s..I` .....:..:..........._ - --- ' ------- <br /> u - t <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 cer 'es the following: <br /> "I certify that ' t p ormance of o for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become le s Comp sation laws o`` California:' <br /> SignedlY. .. ---.. .. . --- - - .-P- ... ..... Owner <br /> -,.. Title ..............-.........----._...... ................................. <br /> (if other than owner) <br /> FOR . PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.....;_. ___ DATE ...?..................... ............. <br /> BUILDING PERMIT ISSUED .......... .. ....... - .... ---- DATE <br /> ADDITIONAL COMMENTS...... . ...............S.......-............... -----------•---- _...................... --•. ............-................... <br /> I __ <br /> -•--......................_-. ------......- _...: .........- ....-.. ......~ ........... .._.......I---- .. <br /> ..-- -- - <br /> - . ................. <br /> ... . . <br /> Final Inspection by; ......__.... .... _............. Date.... ..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I <br /> [ E. H. 9 1-'68 Rev. 5M <br />