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APPLICA 1,1..L a Wk SANITATION PERMIT <br /> .. (Complete in Triplicate) Permit No. ....._. / <br /> -------------------------------------------------- <br /> This Permit Expires 1 Year From Date Issued 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 with County Ordinance No. 549 and existing Rules and Regulations- <br /> --- <br /> JOB ADDRESS/LOCATION ... -c - 7,W-- ---- 't-1-- t--'±-?:_''- :_.r -�l .-`F-----------CENSUS TRACT ................. <br /> Owner's Name -----------. __ Phone <br /> Address r� `._ Z.f,.� � � � <br /> ----- t�:_C!. =' Cit <br /> ? y ----- <br /> Contractor's Name .--- ....1- C_C -.�(.�� r fr _e".* , License #�t{r�.7c� Phone ................... <br /> - - -- <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> / Motel E-]Other <br /> Number of living units:..../-.---- Number of bedrooms .. --___Garbage Grinder ------------ Lot Size ....... <br /> - _:: .. <br /> Water Supply: Public System and name -----------------------------------------------------------------------------------------------...___...----...Private [� <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam En 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 seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size----------------------_---._--.-._--- liquid Depth ...._.._ ................. <br /> Capacity ------ -----.--- Type -------------------- Material----- --------........ No. Compartments <br /> ...................... <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 /> Distance to nearest: Well ------------------------ Foundation ..--..-----.---- ------- Property Line ........................ <br /> SEEPAGE PIT [ ] Depth ------------ ------ Diameter ---------------- Number ------- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth --------------------------•----------•----------Rock Size ..............................-- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ................ .................. ........ Date ----------------------------------) <br /> Septic Tank (Specify Requirements) ------------------ • ----- - ---------•------;-------•--------•----------•--•----••-•----•---------••-----••-------.---_--------- <br /> Disposal Field (Specify Requirements) .- :- C._c7_J_...� �f:a..<.-_,_.. _e�_-•- . ^_c----- '��_- ,=-rx__,�..__.•-•--- - <br /> J =^ r -- <br /> t2------- L------ . - �. ` .�'��a --------------------- <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 /> "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 /> a `) CompensationIIlaws of California." <br /> Sig to become subject to Workman's ned .. .----- . . ( caner _ <br /> "�t.. . ------- ---------- <br /> By --------........ ----_ .- � yl.,Ea-f'7 _--' •-- _(`~4'�t J <br /> -Q°- Title .._�ti/../�.�'.�__+ <br /> (If other than owner) ' <br /> ` FOR DEPARTMENT USE ONLY <br /> rr ( ( ) <br /> APPLICATION ACCEPTED B-- .. �------ -- -------- ---------- fi ----- -----------------_.. DATE ........................................... <br /> BUILDING PERMIT ISSUED ---------------- ------ -------DATE ........................................... <br /> ADDITIONAL COMMENTS . <br /> - ---- -- ---- ----- --------- ------ ------------------_- ------- ---------------------------------------------------------------------- -------- --------------•-----------•--------•----•-•--•-•-•--- <br /> - ---- --..---- •_--•----------- ----------- -------------_--- ----_-.----------------_•-_-- t: <br /> -P y -- ------- - -'- - - -- Date = } <br /> Final Ins ection b <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />