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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ...............­-�............. <br /> (Complete in Triplicate) Permit No. �kf:7.­,'T.-,. <br /> ....... .... . . . .......... <br /> This Permit Expires I Your From0ate Issued Date Issued;_./_1..:.0 <br /> /_ <br /> Application is hereby made to the San-Joaquin Local Health District for a permit fd construct and install the work herein <br /> described. This application is made in"complionce with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ._leo--------.................._......CENSUS TRACT .............. ........... <br /> Owner's Name ....... -----9VA-IR -1-1........ ----------•-------------•-•-----•--- ---...­­----------------PhoneW. <br /> Address _.------6:AW-A---- -------------------..............•--__..._....__..._._ __......... City .................. ....................... <br /> Contractor's Name .......6,r_5�-----------___-------------------------_- ....._Ucense # Phone. ....... <br /> Installation will serve. Residence gl-Apartment House,[] Commercial []Trailer Court ' <br /> 0, <br /> Motel 7 Other ...................... ............. <br /> Number of living unfts....1....... Number of bedrooms -,y-------Garbc!ge Grinder/Vq._,. Lot Size ............ ......... <br /> Water Supply: Public System and name .----------_-----_---------------------- ....... -_-----------­---.._..__•Private <br /> Characterof soil to a depth of 3 feet. Sarrd'o Silt[] Clay [j Peat E] Sandy Loom-[] Clay-Loam L-1 <br /> Hardpan F-1 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 seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAAPE TREATMENj jSEPTIC TANK) I <br /> Size----------------._.._.----------------_..-___-.. Liquicl Depth .---,.•--.-r-__._ --__-- <br /> ty .................._ 16 <br /> CapacityType .......__ Material................__ No,. Compartments ..................... <br /> Distance nearest- Well <br /> ..................................Foundation ..................... Prop. Line ........ <br /> LEACHING UNE No..of Lines-----------_............ Length of each line-------_....._._.._ _. Total Length <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material .___.....-----..-.---_._._...w,.- ..�_. <br /> Distance <br /> ....... ------------- <br /> Distance to nearest, Well ................ 'Foundation ............ Property Line ..--------------- <br /> SEEPAGE PIT Depth ------ ............. Diameter -_1._1....... Number ......................... Rock Filled Yes E] N*,0 <br /> Water Table Depth -•-------_----_------------------•---------Rock Size .... ...... ------------------- <br /> Distance to nearest: Well ------ ..................................Foundation .............__... Prop. Line ....... <br /> REPAIR/ADDITION Prev. Sanitation Permit# ............................................. Date --------------.-.---___.._----•} _ <br /> Septic <br /> ------------- <br /> Septic Tank (Specify Requirements) ............................... ............... ----------_­­­.-.......... ----------- ......... <br /> Disposal Field (Specify Requirements) <br /> ...................----------------------------------------------- ............................................................. ............................................ <br /> .......... ........­.................... ------------------------------------................... ....................... ........................ -•-------,v_........... <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 Son Jdacluln <br /> County Ordinances, State L6ws, 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 perforv;a6ce of the work for which this permit is issued, I shall not employ any person In such manner <br /> as to subject bec rn to Waikman's Compensation'lows of California." <br /> Signed .yorn.. . .......... --------___-_---------_--------_------_---------- Owner <br /> --- -------- - ----------I <br /> By -------- - -------(If..other ...........*------------------------ 'Title '_­___,__------- ............. ----------- <br /> �Wlt DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED _.__...-•---......-----•-------• ......... DATE ....... <br /> BUILDING PERMIT ISSUED ----------- -----•-------•--_..._._............. <br /> -------------..................... ----------­--- ....�DATE--------------- ------- ----- <br /> ADDITION-,AL, NITS... . .... ....... ....................... -­-----------------­­............ ......­­­ <br /> ................ --------------- <br /> .......................................................------------ <br /> --------------- ................ <br /> -----------------­----- ------- ..................... <br /> .............. -�-M................... ------ --------- ------------- ------ ------ <br /> ....................... -------­­­_­­­. ............................... ------------------------------------ - ---------_ I <br /> Final Inspection by: ........._. ..__.Date ...... <br /> ---------------- ........... ..... ............... <br /> SAN.JOAQUIN LOCAL HEALTH DISTRICT <br /> E.H. 9 1-'68-Rev. 5M <br />