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FOR OFFICE USE: 4` <br /> APPLICATION FOR SANITATION PERMIT <br /> _er•mit.No._7/__$__Z <br /> �` {CompleFe in Trip[icafe)� <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 ❑ 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/LOCATION _ �/ --_--- --- _ -- CENSUS TRACT -------------------------- <br /> '} <br /> - <br /> Owner's Name ......' xf--c----------- ------------------------- --------------------- --------------------------------------Phone <br /> Address - - --- - ---------------- ----------------. City � <br /> _ <br /> Contractor's Name __94 a1___�Z �___�__ _ "- . <br /> � -�-f- ----------- --=-=--------License # �"6bsA ------ Phone <br /> Installation will serve .� k.. Residence Apartment House(] Commercial :❑Trailer Court i❑ <br /> Motel ❑ Other ------------------------ ------------------ <br /> Number of living units:-----I----- Number of bedrooms ___I_ Garbage Grinder ---------- Lot Size __-._-_____________________________________ <br /> Water Supply: Public System and namec ------------------------------------------------------------------------_Private ❑ <br /> t <br /> ----Y_ <br /> Character of soil to a epth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,❑ -r <br /> Hardpan ❑ Adobe Fill Material ------------ If yes, t pe ___________________________ <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: a '�'� [ <br /> {No septic tank or seepage�it permitted if public sewer is available within 200 feet,] p� F <br /> PACKAGE TREATMENT [ ] SEPTIC TANK![v] - ' Si e------------------------------------------------ Liquid Depth -------------------------- <br /> Capacity <br /> ------------------------- <br /> ' Ca acit r <br /> p y ____________________ Type _'___ Material__ _______ No. Compartments <br /> �! Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- N <br /> s <br /> LEACHING LINE [ ] No. of Lines ........ <br /> � --------- Length of each line---------------------------- Total Length ---------------------------- <br /> 'D' <br /> ---__.__-- _______________ <br /> 'D' Box .----------- TypeFilter Material --------------------Depth Filter Material ------------------------------ .............. <br /> Distance to nearest: ell ________________________ Foundation --_-_____________-__-- Property Line __________--__.._--___ <br /> SEEPAGE PIT [ ] Depth ---_N______________ iameter ---------------. Number _._______--._-_.----__--__ Rock Filled Yes ❑ No i❑� - <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> x=st Foundation <br /> Distance to nearest:rWeli ________________________ _______ Prop. Line _________-_______--___ <br /> REPAIR/ADDITION(Prev. Sanitation Permit#_ ____________________________________________ Date _____________________________._.__) <br /> SepticLank (Specify Requirements) r'------------------------ ---------------------------------- -----------•-------------------- ---------------------------_-- a <br /> Disposal Field (Specify Requirements) ______ <br /> - - - ---------- -- ------- <br /> --------------- -------------------------------------------------------- - ----------------------- <br /> # i (Draw existing;aid required addition on reverse side) <br /> I hereby certify that If have prepared this application andathat therwork will be done in accordance with San Joaquin ' <br /> County Ordirianc s,�State Laws, and Rules and Regulations of the San�Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: '4- <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 ---------------- ^ Owner <br /> - ------------------------------ <br /> BY --- e ----- - ---------------------- ---------------- Title ........................................ ---------- <br /> if dther than Own <br /> ARTMENT-USE-ONUY <br /> APPLICATION ACCEPTED BY ----------- - --- --- -- •- - -- -------------------- ------------------- -- - DATE -.-- �=-��-�•��---------- <br /> T <br /> BUILDING PERMIT ISSUED '=---- ----- --- - ----------- ----------------------------------------- - DATE ----- <br /> ADDITIONAL COMMENTS ---___-__l _ ------------ _ ____ --- <br /> ---------- <br /> ------------------- <br /> _---- --- - ---------- <br /> r - <br /> ---------- -------------- -------------- <br /> --- -- - ------ -- - ---------- ------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------- -- ---- --- -- --------- ---- ---------------------------------------------------------------------------------------------------------y. ___.. <br /> Final Inspection by: - ----------------------------Date --- _r-.Zyl -� - ------ <br /> A JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Re . 5M <br />