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FOR OFFICE USE: I <br /> APPLICATION FOR SANITATION PERMIT <br /> �.......... ........ Permit No. 7. cls <br /> .................... <br /> 1Complete in Triplicate) <br /> ............................... This Permit Expires I Year Frain 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 /> JOB ADDRESS/LOCATION ...../`_... 1 .'........ /.I?.F .........;r1#1,e.............................CENSUS TRACT .......................... <br /> Owner's Name ..... .....................................................Phone <br /> Address .., .: ,5—..__..__ ................................ <br /> . city ` ....:,. ..' . . J <br /> ... Z.. _ %'.� <br /> Contractor's Name .........?4-. .. ..---. r��_� r �-- .-•--•. license # Phone....�f.?.-- <br /> -••!--/�---r--�--• <br /> , <br /> Installation will serve. Residence`Apartment House 0 Commercial❑Traller Court ❑ <br /> Motel ❑Other............................................ <br /> Number of living units:...__... Number of bedrooms .. ;�-----Garbage Grinder F_-- Lot Size ..&�------__-------------. . . _ <br /> l Water Supply: Public System and name ........-....................•.....---------------------_....................................................Private <br /> Character of soil too depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe 0 .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 fest,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK( ] Size..:" .k. ....................... liquid Depth ..._'..... ..............6 <br /> Capacity 1;00,1 } Type •------------------- Material_ .... No. Compartments .........6 <br /> Distance to nearest: Well ....ITO.......................Foundat€on _effix <br /> .......___.. Prop. Line --I.1.. .............�/' <br /> LEACHING LINE [ ] No, of Lines ........A•-1_----- Length of each line...... .?d"Total Length _-. . <br /> .� a� <br /> i <br /> 'D' Box .... ..... Type Filter Materia ..1 0C{.&. ......Depth Filter Material ......i 7�..-.---.--Y_-_--............. <br />! Distance to nearest: Well ---�. •..-....... Foundation " ............... Property Line .�..��..._......__...... Jb <br /> SEEPAGE PIT [ ) Depth Diameter ................ Number ..................... Rock Filled. Yes ❑ No �❑ 1 <br /> Water Table Depth ......................-.........................Rock Size _•-............................ <br /> . <br /> Distance to nearest: Well ........................................Foundation -_.................. Prop. Line -•-------...____----_I" <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...............................`-........ -- Date ............................—.1 <br /> Septic Tank (Specify Requirements) <br /> :..........................................................I............................ <br /> Disposal Field (Specify Requirements) ------....................... --------------------------------------- .............. ....... <br /> __.•-,�...... . ¢,i _ . .. .. _. ......................... ................................................ <br /> . . <br /> ._._'.-._41 .. P61­.-A pal, <br /> .1 F, �.. (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I havilpftpored this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State �aws, and Rules and Regulations of the San Joaquin Local Health District. Hoene owner at licen. <br /> sed agents signature certifies'tho following: <br /> "I certify that in the performance of k for which this permit is Issued, I sholl not employ any person in such manner <br />` cis tobecome subjec t Wor n' CompetAotion laws of.,California." <br /> Signed ....----- . . ... _ Sr: � ?:: "_�._. Owner <br /> By .. ... . .......................... . • Title ........_...... <br /> (If other thari owner) <br /> OR REP ME USE ONLY <br /> APPLICATION ACCEPTED W1..S. ._-•_-. DATE .- -� .�_ _`_7_ -----.----- <br /> BUILDINGPERMIT ISSUED ...................•---•----...•-•--•---..............--•---• --- ----- - ..................DATE _.----------------------------•------------ <br /> ADDITIONAL COMMENTS ...........------------....-.....................:..................... <br /> •....................._....__...__........ <br /> ..................... <br /> .-•..................................................••-- ...... ........................................ <br /> .__......... <br /> •-----•-------------------------------- - ....... ----- •-•---•---- I.....•----...--•----- .__._._.._..---•-•------- ................... <br /> Final Inspection by: ...... -- ---•.............•- ...............---...._..---..... ................Date _ - <br /> - ----- - - -------•-- <br /> EH 13 2L 1-68 Rev. 5m SAN JOAQU LOCAL HEALTH DISTRICT $�7h 3M ,',: <br />