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F FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) <br /> Permit No. J---------9- <br /> -- <br /> ---------------------------------------------------- <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> 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/LOCATION ------ _ -------------- ---- - - -- - ------ -- :--- <br /> ------------ ----.----CENSUS TRACT --------------------- <br /> Owner's Name Phone� _____ <br /> --- -------------- = 6 - 4C . <br /> Address -------------- oZ ------- ' city �' �/�c '-` <br /> �� ----------- <br /> Contractor's Name -----------� ________________License #v l-"Z.`J___ Phone <br /> Installation will serve" Residence [Apartment House❑ Commercial :❑Trailer Court i❑ <br /> I <br /> Motel ❑ Other --- ----------------------------- <br /> Number of livingunits:______ _._ Number of be ooms _ _ _ - .��-G'!u --_______ <br /> I - - - g- ------------r ------------ Lot Size ---- -------- <br /> Water Supply: Pblic System and name _----_ .C,_ Garber _ _" Private <br /> r <br /> Character.of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ ' <br /> # Hardpan ❑ AdobeFill 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 public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK;X Size____ ,z --- ___. `__l�_(_p_.__.____ Liquid Depth ____ _._............... <br /> CapacityAl-4, ..Type �� Material---��t�- __ No. Compartments —-------------- <br /> ------------------Foundation ---�' ----- <br /> - Prop. Line ------ / - <br /> Distance to nearest: Well ____-__��� ' -- <br /> LEACHING LINENo, of Lines _-___ _____________ of each Len th line.___ _"G'_a" f, %" <br /> g .� Total Length -------------------- <br /> 'D' Box ___/ ---- Type Filter Material __400-c-16___.Depth Filter Material __-! ----------------- ...... <br /> Distance to nearest: Well _____± _ ------- Foundation _____/B------------- Property Line ___- _�-.__._.._- <br /> SEEPAGE PITDe th <br /> p _�: "______ Diameter �_�______ Number ----,_c ------------------ Rock Filled Yes 2�- No i❑ , <br /> Water Table Depth --------F��--------------------------------- <br /> Rock Size ----------_--- -:------------- <br /> Distance to nearest: Well --------------------Foundation _f`ff_- -___ Prop. Line ___-______ ------ <br /> REPAIR/ADDITION(Prev. Sanitation#Permit# ...__-.-__;________________________________ Date _________,_._,___________________) <br /> SepticTank (Specify Requirements) ------------------- -------------------------------------------------------------------------------------------.---------------------------- <br /> { <br /> Disposal Field (Specify Requirements) ----------- ----------------------------------------------- <br /> ------------- ------------------------------------------- --------------- <br /> { <br /> -------------------------------------------------------------=-------------------------------------- <br /> ------------------------------------------------------------------------------------------------------ <br /> i <br /> i(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 /> as to become subject to Workman's Compensation laws of California." <br /> Signed ---- <br /> ------------- ----------------------- Owner <br /> ------------ - -------- <br /> By ........ L �__ _ ---------------------- Title Lr <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- --------------------------------------------------------------------- DATE -----------•--------- <br /> BUILDINGPERMIT ISSUED -------------------------------------------------------------------------------------------°--------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ;------------------------------------------------------------- -----------------------------------------------------•--------------------------- <br /> --- -- <br /> -----------------I------------------- -------- <br /> -----------------------------------------------A-------------- ------------------------------------------------------------------------------------------- ---------------------------------- <br /> ----------------------------- <br /> - -- ------- - -- ----------------------------------------------------------------------- ------------- ------ <br /> Final Inspection by: -- - ----------------------- - <br /> - - - ----------------•-----------.Date ----"�=--- -------------- <br /> ---- <br /> -~ ----- - - - - - -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> N'w A s <br /> E. H. 9 1-'68 Rev. 5M <br />