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' I <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No'. <br /> [Complete in Triplicate] . <br /> ---------------------------------- - d <br /> ---------- ------- Date Issued ---- ---,----•-- <br /> This Permit Expires 1 Year From Date Issued <br /> { I <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: E <br /> JOB ADDRESS/LOCATION ..-Tf� D.dflN <br /> RP----------------------- ---------------------CEN US TRACT __-,-----------•----------- <br /> ''//�l 5 <br /> Owner's Name --- ---- - �-- ---=--�`---==- ---------'••-------------------------------------�-- - ---------P one --------------•-----•-----•----•---- { <br /> - a <br /> Address !.!< ��✓ +L°D City O J-- ----------- - <br /> --'---•License # -...,.. Phone.-.----------- ----- <br /> Contractor's Name - 1T/Mt1����,�-----------------`----------- 3 ! <br /> Installation will serve: Residence O<Partment'House°❑ Commercial ]]Trailer Court <br /> Motel ❑ Other ---- r <br /> Number of living units:---- Number of bedrooms _ --_':_Garbage Grinder -- --___. Lot Size -�� - -x --�- - <br /> ` ° <br /> ----------- -Private ❑ <br /> Water Supply: Public System and name -------------------------------------------- --------- <br /> Character of soil to a depth of 3 feet: . 5and'�ilt❑ Clay,❑`°� Peat❑ Sandy Loam -F-1 Clay Loam [:] I� <br /> Hardpan ❑ Adobe [] 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 /> r 1 <br /> AV <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if u'blic sewer is available within 200 feet,] 1 <br /> G PACKAGE TREATMENT [ ]' SEPTIC TANK'[ ] � -_� <br /> fin( S/i/zre�-------1�---=---'�'--•�----- _---�-;�------- Ligv�d Depth ---- ----------- <br /> �S' `Gt'T.7/ I `i�y i <br /> Capacity ---1 G -.--- Type ------ Material 1'------------------- No. tCompartments ____--•- <br /> ►t Distance to nearest; Well ---- Ct ---'_----------- Foundation _� ------ --------- Prop. Line -/G._-�_._:__-.__-- <br /> - r... . Length of each line-t n <br /> ---- Total Len <br /> 9 <br /> LEACHING LINE [ ] No. of Lines_ __,3-_ - <br /> D' Box``__ -Type Filter Material'` __4-� Depth Filter Material __� -------------- <br /> --------------- I <br /> _. <br /> S.. <br /> --------- Foundation -------------- Property Line <br /> Distance to nearest: Well "---___---__" ---------- <br /> ' SEEPAGE PIT [ ] Depth•-----.t"------"-- Diameter ---------------- Number ---------------------------- Rock Filled Yes (] No <br /> Water Table::Depth ------------------------------------------------Rock Size -------------------------------- <br /> Of <br /> ------------------------ ----- <br /> Of t <br /> - ----•--------Foundation -------------------- Prop. Line ---------- ----------- I� <br /> i , <br /> Distance to nearest: We <br /> ----- --------------- ) , <br /> C REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------=---------•---------•---- <br /> i <br /> Septic Tank [Specify Requirements] ---------------- <br /> --------------------------------------- - -• --------------------------------------- a <br /> Disposal Field {Specify Requirements) ---------- -- -----A. <br /> ------- -= <br /> e <br /> - --------------- ----- --------------- <br /> -------------------------------- <br /> --- ---------- ----- - - -----------------------------------~-=-----------------------------------------`"---------- ----- ------------------- <br /> [Draw existing and required addition on reverse side] <br /> I hereby certify that 1 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 o nn tion Laws of California." sz <br /> Signed _ - Owner <br /> -- - --------- <br /> Title . - --=--- <br /> By <br /> (If other than owner <br /> FOR 7DEPARTMENT USE ONLY <br /> r DATE1 � I <br /> f APPLICATION ACCEPTED'BY ------- - -------------= = `.-7 `. . ':` = DATE <br /> 1. ------------------------------------------- <br /> BUILDING <br /> --------------- ' <br /> BUILDING PERMIT ISSUED ------------- ------------------------------------- - = -= . - <br /> ADDITIONAL COMMENTS ----------------------- - ---------- ----------------------- <br /> r ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---- ------- '---------------------------------- <br /> ------------------------- 4--- <br /> ---------------- <br /> Date `-- <br /> - ----= ------ ---------------- <br /> Final inspection by ---=�- v w <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT r I <br /> E. H. 9 1-'68 Rev. 5M <br />