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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PER ' <br /> -------- ---------------- ------------------ (Completer Tr* I' ate) s Permit <br /> o.7__7_---9-7- <br /> _7 <br /> ------- ------- ------------------- - <br /> �Vjga� <br /> 7_7 ] <br /> "" This Permit Expires ear Fro <br /> Application is hereby made to the San Joaquin Local Health District for a permit to co�truct�stil e work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: F <br /> JOB ADDRESS/LOCATION---/�.5..--�.�/fid.-- r -- -- <br /> E 4ti9�k_IO �-----------------------CENSUS TRACT------ --- -------- ----------- <br /> Owner's Name ��. -------- ----_P one <br /> Address------------- - --------- C. --------------------- <br /> `CitY1-' °` ip Z <br /> P�? <br /> Contractor's Name uj. �` ------------------------ --License # .__?. Phone----`-1 + <br /> Installation will serve: Residence ]"i Apartment House ❑ Commercial ❑ Trailer Court.❑ <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 /> 1 Hardpan❑ Adobe Fill Material_-----------If yes, type------------------------------- <br /> (Plot plan, showing size of lot, location-of—systemin 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 feet,) <br /> r <br /> PACKAGE TREATMENT—[')—SEPTIC TANK V4 Size-----���"-'� �""""'"_ " Liquid Depth <br /> r . -- -;---�Lcp-- <br /> '—-------_t-_�V}L� No. Compartments-- ------------- <br /> Capacity ------Z.t - - 7Y e = - -- Material_ec <br /> --------------------- --Foundation---------- --- -------- rop.. 1ne --80-- <br /> -- <br /> ` <br /> Distance.to nearest: Well <br /> LEACHING LINE. Na. of Lines.-----------` ---------------Length of each � ----- Length <br /> ri <br /> D' Box--i-5_ ----Type Filter Material-5WI2*X.....Depth Filter Material------- __.....--_ - ---- ----.---- <br /> ' ' <br /> Distance to nearest: WeIL_:._1. _.... - Foundation___..."Z -_--.____.Property Line_ ..-- --_-.--- <br /> SEEPAGEIPIT [ } Depth--. o ----.Diameter._.-_- ___._. <br /> Number-----------'Z__----------- Rock Filled_ Yes No <br /> Water Table.Depth--------------- «---------------------------------Rock Size---------------------------------- ------- i <br /> t �.,.,..� Lrir ...� - — � ---------- <br /> --.Foundation-.--.- .__... <br /> Distance to nearest: Well-_----...-�- �--------------------= -- --------- -.Pro Line.-..-- --- <br /> t o- p- ; <br /> REPAIR/ADDITIO N'[Prev. Sanitation Permit#------- -----------------------------------------Date----I..--------------------------------------- --------------- <br /> 1 f, <br /> Septic Tank (Specify Requirements)-_------- ,.._,..�.__ _.-_---- --- - - <br /> Dis.posal'I'Adt(Specify Requirements)-- ----------------- - -----------------------------=------------------------------------------ ----------------- <br /> y + ------------------------------------------------- <br /> -------------------------------------------------------------------- --------------------------" _ <br /> (Draw existing and required addition on reverse side) <br /> f I hereby certify that,I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> "I certify that intthe.perforMance of the work for which this permit is issued, I shall not employ any person in such manner as �# <br /> to become subject tc+ Workman's Compensation laws of California." <br /> Signed - ------ - ---------------- -------------- <br /> --- --------Owner / <br /> L <br /> Title.. ' -- --- ---� } 1 <br /> By L� - <br /> (if other t an owner) <br /> FOR DEPART ENT USE ONL <br /> APPLICATION ACCEPTED. BY = DATE. L -7-'�7 <br /> -----=------ <br /> DIVISION OF LAND NUMBER--------------- ------- -- ------ - DATE <br /> ADDITIONALCOMMENTS ----------------------- - ------------- ---------------------------------------- ------------------ --------------------- ----_..... <br /> --------------------- ------------------------------ ----------------------------. --------------------- -- <br /> ---------------------------------- -- <br /> -------------------------------------------------------------------------- <br /> T <br /> =------------------------------------------ ------ -------------------------------------------------------------- <br /> Final Inspection b _____ __----------------------------------------------------=---------------- -Date = -------------- <br /> p y:::- - -- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fos 2,en eev. ���a 3M <br />