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r FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> �.' IComplete in Triplicate) <br /> Permit No. .7 <br /> ............................--- This Permit Expires 1 Year From Date Issued Date Issued <br /> -3 e CJ-- 2--_5' <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.&d existin ules,pnd�gulations: <br /> 36 <br /> JOB ADDRESS/LOCATION . �...__ l.. '_ .CJ_: ....._ T' ...-'f��----.--------- E US TRACT ...................... <br /> j � <br /> Owner's Name _ .. ..... .....�.GI......................... .... .....Phone ................................ <br /> Address . .. �� / ( /�� _. City,.,. _ ..� ...................• - <br /> - i <br /> Contractor's Name .......:.. C`�.: ?.... fj.(f`-.... ....... ......................License # c�--�f- - 1r Phone <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other .......... ..............<.:..-._ ......... _ ,.....} <br /> Number of living units:.. . _.' <br /> , .. Num _ <br /> bee;of ooms... . ..._Garba a,Grinder ..G ... Loi Size ._-..�. ... . W i <br /> Water Supply: Public System and name ,*/ <br /> r ............. <br /> '...-- _ ° .. ...............................................Private ❑ � <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat#❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ #Adobe ill 1Vlaterialy <br /> if yes,type __:... ................ <br /> 1Plot .plan, showing size of lot, location of.system .in relation to-wells, byildings, etc.: must be.placed -on reverse side.) <br /> NEW INSTALLATION: {No septic tank or seepage pit,perrnitted if public sewer is available within 200 feet,) t <br /> PACKAGE`TRtATMENT [ ] SEPTIC TANK.: ze.r ..� �. - - - ---- ---.._...---- Liquid Depth,.° ...... <br /> x, , <br /> Capacity�a� Q-+-_- Type- �/. .Matei Hal_-- - No: Compartments�' <br /> ! D' tante to nearest: Well' _tq`--.---?--.•-.-•---Foundation ... .............. Prop. Line .... ---._..._ _ <br /> ;.... ..- <br /> ' ; . O <br /> LEACHING LINE No. of Unes -- ... Length X <br /> faeh line .;.. 5 'Total Len th _.,�.w..�_... .. . <br /> e.]'TWe Filer-Material --------------Depth. F iter Material -. f. <br /> D. B.pk <br /> . / .----.._..-- ----------- <br /> istancXto" <br /> nearest: Well _.... : Foundation -: _- .:. - Property line :...-•_-,_ \ <br /> [ p Diameter '--. Number <br /> SEEPAGE PIT Depth .�-S.. �__.... � � ... .......... _. Rock Filled Yes g3- No ❑ <br /> - �:•..:. -• � - ----Rock Size :-• ---�,�...�C�.;-._... <br /> i Distance to nearest: Well ..:.. .__-------------- <br /> Water Table De Depth .o:. ... ............ .. .... <br /> �✓. ._:.._ Foundation _ Prop. Line .. .............. <br /> - � ' <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- `-- , Date .. -- :-~^•----.._' <br /> I Septic Tank (Specify Requirements) <br /> I ` .. I. <br /> .. .. .... ................ -- ...--.---•• <br /> Disposal Field {Specify Requirements) .... <br /> _.... <br /> --------- ------------------------------ _......_..-----.......----- ------------•-- ......•. ---.......--...... .............-.._ <br /> ,- >^ <br /> .................. .. ................. ... <br /> (Drtiw existing and required addition on reverse side) <br /> hereby certify that I have prepared this application and that the work will .be 'dons in.accordanci with...San Joaquln' <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Horne +owner or licen- <br /> sed agents signature certifies the following: i <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." v ; <br /> Signed .:. _.. ...... .... ------------------------------ Owne r <br /> By .... ..... .... .. . . ......._ Title �...... . ------ <br /> a <br /> (I a er than owner) FOR DEPART ENT USE ONLY I <br /> APPLICATION ACCEPTED 8Y .- .. - ............ DATE .7.., ....._.__--. <br /> BUILDING PERMIT ISSUED ......... ....-DATE .....................-----------------------•-------- . <br /> ADDITIONAL COMMENTS .................. .......---..............-t - ! •---- ................ <br /> ---------------- .....------.._. ........ -........_.... -•....------•---.-- ......... ........ ....... ---------------------------- <br /> I ------•-•----•------------------------- - --- - ----------- -- - ............. ......-4_._`..._..-- --• --•- - - .... ...._•-'------•--- <br /> Inspection b <br /> Final Ins <br /> P Y: .......................... ................. ...........•--.._..--- -------.-----...----....-- •-•-=•--------------Date _.,�..�. �•--- -. ..-•-•-•-•---•- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT' <br /> E. H. 13 24 1-'66 Rev. 5M �` ._�. :..,.,. 7/72 3 M <br />