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FG? OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT f� <br /> --------------------------------------------------------- Permit No. <br /> (Complete in Triplicate) <br /> ---- y <br /> -------------------------- This PermitExpires,.l Year From Date Issued <br /> Date issued <br /> Application is hereby made to the San Joa uin Local Health District for permit to construct and install the work herein <br /> PP Y q <br /> described. This application is T d%12 mpliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ` /6 - CENSUS TRACT <br /> Owner's Name ----��--- f - ' --- - ----- J: Phone . <br /> Addressf' r f--- yyyy �'ityt°t City - ( ,1----------------------------------------- ---- ------ <br /> Contractor's Name ._. ;eo,- / ----_______________________________.License # �.�� _- Phone j/ -- <br /> Installation will serve: %.1 -:.Residence [:] Apartment House,❑ Commercil,J'Traller Edi❑ <br /> ' Motel ❑ Other ------------------------------------------ <br /> Number of living units:-.__ - Number of bedrooms ___'__Garbage Grinder -._ Lot Size " ''____"___________ <br /> Water Supply: Public System and name ---------------------------------- ------------------------------------ --------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay .❑ Peat ❑ Sandy Loam -❑ Clay Loam ❑ <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 sid1 <br /> NEW INSTALLATION: (No septic tan4C or seepage pit permitted if public sewer is available within 200 feet,) ' <br /> PACKAGE; TREATMENT SEPTIC TANK' Size___ _ y .�� <br /> { 7 fJ �� --------------------- Liquid Depth <br /> Capacityl_,Zee--------- Type ___ MaterialAW!_71- ------ No. Compartments i.. S <br /> Distance tornearest:_Well ___._�r -,_____ Foundation ,,; --------------- Prop. Line ______________________ <br /> LEACHING LINE ) No. of Lines,_'__,--_.___ - _._ Lie qth of each line✓ X ______ Total Length Zoe________________ <br /> D' Sox __ Type Filter Material/ Vit° ___De�tb Filter Material _ _°-__________. <br /> Distance to A�a.(est: Well ----------- Foundation ---------------- Property Line, /1.1-701------------- \\J <br /> SEEPAGE PIT x{ Depth ``"` _.._ Diameter �'r--- Number __ -__---------------- Rock Filled Yes No . <br /> Water Table Depths-------- ` 1 -----------Rock Size �------_-_-__-- <br /> - --------------------------- <br /> R ' <br /> Distance to nearest:,Wel I __._.,tf ----------------------Foundation <br /> ----- Prop. Line ___.__� ---------- <br /> REPAIR/ADDITION(Prey. Sanitation Permit# _y- ` <br /> �i e✓. <br /> � --- t ,' ---------------------- Date _ <br /> Septic Tank (Specify Requirements) -------- -- ------------------=----------------------------------------------------- ------------------------ ----- -- <br /> • <br /> Disposal Field (Specify Requirements) --------^......_' -------------------------------------------------------------------------------------------------- <br /> ------------------------ ------------ ------- -------------- . <br /> (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 /> "1 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 = -'Title -(� fl� --- ---- ------------------- <br /> If oth an owner) <br /> . FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------------------------------------------------------- DATE l`. - ------------------- <br /> BUILDING PERMIT ISSUED ------- ---------- ----=--------------DATE ------------------=--------------------.. <br /> ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------------- ----------•---------------- <br /> ----------------------------------- -- ---- ----------------- - ------------------------------------------------------------------------------ -------------- ----------------------- <br /> Final Inspection by: -- -- - - - - ------`-------------------------------------------------------------- <br /> -----------Date/7-3--7-2' ------------------ ---- <br /> SAN,JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />