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FOR OFFICE USE: '---APPLICATION FOR SANITATION PERMIT <br /> -----m---------- --------- (Complete in Triplicate) Permit No, 2 <br /> --------%Z 31-4 5---T_V\----------- Date Issued <br /> -------------------------------------:--------------- This Permit Expires 1 Year From 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 /> JOB ADDRESS/LOCATIO. ----------- ----- --CENSUS TRACT -------------------------- <br /> Owner s Name --------- ---- - --- ---- ----- ------- -- ----- <br /> ,9,---- <br /> --.e_ � <br /> - -- ----- --?.---.7,--- Phone- --- ---------------------------- <br /> L— ------- --- <br /> Address ----4T­5?e_ ---------W___ ----------- ------------------------------------ City ----- ----- ------ --------I............. <br /> Contractor's Name ------ ----- --- -- -- -- -- - ----- License # Phone ______________________________ <br /> Installation will serve, ResidencieApartment House0 Commercial FlTrailer Court F-1 <br /> Moe ❑ Other ------------------------------------------- <br /> Number of living units.--../------ Numberof bedrooms _______Garbage Grinder ------------ Lot Size -------------------------------------------- <br /> Wafer Supply: Public System and name -------------------------------------- -------------------------------------- ---------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'E] Silt E] Clay E] Peat E] Sandy Loom [-] Clay Loam 0 <br /> Hardpan E] Adobe-RI/ 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 /> IN, <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) W <br /> PACKAGE TREATMENT SEPTIC TANK <br /> Size ,_p---- ------r------------------- Liquid Depth _#--------------------- L4 <br /> Capacity -JP "n., M No. Compartments .. <br /> ...... .... <br /> - -,00 J __ Type <br /> C <br /> Distance to nearel- Well -----------5- _r_______ Foundation --------- Prop. Line _7�� <br /> ................. <br /> LEACHING LINE No. of Li-nes -----z;;�------------- Length of each line-------F-4:7--0----------- Total Length .____/_7A_/-.......... <br /> Box Type Filter Material -------- ------ <br /> -----Depth Filter Material ------ <br /> - - ----------------------------- <br /> X­ <br /> Distance to nearest. Well ------------ Foundation -----kv--t----------- Property Line ............ <br /> r/ <br /> SEEPAGE PIT Depth �,_,AV---------- Diameter Number --------=2--------------- Rock Filled Yes Er No 0 <br /> Water Table Depth -----------------�-I�---f------------- -------Rock Size --------------------------------- <br /> Distance to nearest: Well --------I P-0---------------------- Foundation ------ ----- Prop. Line ...S----I--------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date __________________________________} <br /> SepticTank (Specify Requirements_ -----------------------------------------------------------------------------------I--------------------------------------------- ------------ <br /> DisposalField (Specify Requirements) ---------------------------i------------ --------------------------------- ------------------------------------------------------------ <br /> -------- ---------------------------------------- ------------------------- -----------;----------------------------- ----------------------------------------------------------------- <br /> ------------------ ----- --- -----------I-------- -------------��-;-----------:-------------- -------------1-------------------------------------------------------------------------------------------- <br /> (Draw exi'sfi'n'g:and required addition on reverse side) <br /> I hereby certify that I have County Ordinances, State Laws, <br /> this application and that the work will be done in accordance with Son Joaquin <br /> 0, and Rules i <br /> and-Regulatio s 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 Workman's Compensation laws of California.' <br /> Signed -------------------- _, W ----- --------------------------Owner— <br /> By ----------------- <br /> -------------------------------------- <br /> ------ "Titl- ----- <br /> (If other than owner) <br /> 0PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ --------- --- ------------------------------------------------------- DATE ---------------- <br /> BUILDING PERMIT ISSUED ------- ---------------------- ---------------------------------DATE --------------------------------- -------•- <br /> f. COMMENTS <br /> -----I--- ----- ----- - - -- ------------------------ <br /> 1�� ----------------------- <br /> -------- -- ------------------------------------------------------- ---------------------- <br /> -- <br /> :---------------------------------- <br /> -------------------------- --------------------------- -- ------- -- ----- ---/_ -- -- ---------------------------------------------- - <br /> Final Inspection by: --- ----- -- ----- - -----------------------------Date ---- ---- e�..C7---- <br /> ---------------- <br /> SAN 'JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br />