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r _ " <br /> FOR OFFICE USE: PLICATION FOR SANITATION PERMIT / <br /> ............ ....... . ..................... 1 J — Permit No. ._f�.J�-(F 5� <br /> ......... ..........•--..... ..-- •-------.------ L - . <br /> (Completeln Triplicate) <br /> : <br /> Date Issued -.777/4.-1� <br /> .......... .................................... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit toconsd install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ......:___.......CENSUS TRACT ............. <br /> �� <br /> 11 <br /> Owner's Name ....Y_... - •---•----•........... ............`----.............,........... Phone �3.Q..s { <br /> ..._ <br /> o <br /> Address ... P4.... . City ._ <br /> .... { <br /> Contractor's Nam ---.....--_---------------- ..._.- --••---- .........License # _ __,_------------- Phone -- -----------•---•---- <br /> i Installation wil( serve: Residence X Apartment House❑ Commercial❑Trailer Court 1❑ <br /> Motel ❑Other .-- ------- ------------------------- <br /> Number of living units:............ Number of bedrooms _3.......Garbage Grinder ..._.. ----- Lot Size -k._a'' OO <br /> Water.Supply:Public System and name --------------------------------------------------------- ............................. ... ...-..........Private <br /> i <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat Q SariClay Loom�[. <br /> Hardpan Adobe 0 Fill Material ..-_.. .....If yes,type................_ <br /> f (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,) <br /> ,,..� . PACKAGE TREATMENT [ I SEPTIC TANK f ) Size............................................._._ Liquid Depth ._------__.._.-....,..__. � <br /> Capacity -------------------• Type ....---------------. Material...................... No. Compartments .................. <br /> Distance to nearest: Well ....................................Foundation _..----------_-.---_ Prop. line --............:-,...... <br /> i <br /> LEACHING LINE [ ] No. of Lines .... ........... Length of each line------------------- Total Length ................ <br /> D' Box ----- ------ Type Filter Material --------------------Depth Filter Material ...--------.------.-_ ---•---------. ---- <br /> Distance to nearest: Well -------- _--_-.--- Foundation ..........--..--.- ----- Property Line ............ ....... <br /> SEEPAGE PIT [ ] Depth .... ............... Diameter ................ Number ---------- Rock Filled Yes ❑ No i❑ <br /> Water Table Depth ......................... ...................Rock Size ....•...... -------_-- <br /> Distance to nearest: Well ........................................Foundation .............----.-- Prop. Line ........._._---....-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -.-_---------- ••------_- Date ..................................) <br /> j Septic Tank (Specify Requirements) ........................ - ----------------------------------- <br /> ------ ---------------•--••----••-------------•----..---.--- •-•---------•----.._.._..� ----•------- <br /> Disposal Field (Specify Requirements) .,..�, ..�. a' ...... ................... -•-- --- „ <br /> ...........................................................................................----------------- -•-•-----•----............ -• ••........---------------------• ................. <br /> ............ -•----------•----•---•• ........................ . ...•---.........;..---------••-------•---------------...•...-------•- - _....._. ................. <br /> (Draw existing and required addition on reverse,side) <br /> 41 hereby certify that 1 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 /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner <br /> as to become subject to Wbrkma is Compen a� aws I ornia." <br /> Signed -- - -- -- f•--• - - -- .. ... <br /> Owner <br /> By ........___.---._.... ------------------------- Title .___..........------..._......-_... ..............-----------------­- <br /> (if other than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> l APPLICATION ACCEPTED BY_ . <br /> - ---._, DATE .h.:l '..'. .......... <br /> PERMIT ISSUED ...... _.__...•.' " _ '... - ....... ..._ DATE ­ -- ....... <br /> ADDITIONAL COMMENTS .... .r!�'d --------------_- <br /> ............. ........... -------------- <br /> r -----. <br /> ....................................................------•-------- -•-•----- -- .------------.- --------------.--- - -----........-••----------------- ......... I . ..... <br /> ..................................... - .. -----.�. .. . -------- <br /> Final Inspection by: -- ----_ -0-•-_-_------- •-----_._.._.........- --... Date -.. ... �. --------- <br /> Final <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 . 1-'68 Rev. 5M <br />