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�I <br /> ,FOR OFFICE USE: ! <br /> } APPLICATION FOR SANITAfiON PERMIT <br /> Permit No 7K <br /> (Complete in Triplicate) <br /> ............... This Permit Expires 1 Year From Dat*Issued <br /> Date Issued !�K.7y_. I <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 /> r described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> } ` -�. <br /> JOB ADDRESS/LOCATION .: j _ CENSUS TRACT ............. <br /> ............ ..... ... <br /> i Address r .. ............... <br /> - Phone <br /> D <br /> ......... .�... ... .. ._ �.__. .�.: -------�----._.. city -. -����_.' <br /> } Contractor's Name ....... ------ = phone . <br /> " Installation will serve: Residence VApartment House❑ Commercial ❑Trailer Court ❑ f <br /> Motel ❑Other .. -- ...... ....... r r <br /> Number of living units:.._.,.. _:-.;, Number of.bedrooms �.._.. ._....Garbage.GrinderA(1.Xe_ Lot Size .. ----------------------------- <br /> Water <br /> _._______________ ________Water Supply: Public System and name .........................................................:..........................._:-...,......._.._.:.----Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ i <br /> Hardpan ❑ Adobe R' Fill Material ............ If yes, type ...................... <br /> (plot;,pian„showing rsrze of. lot,.location of system in-relation to :weEfs,..buiidings, etc.. must..be.-placed .on reverse sid; <br /> } NEW:INSTALLATION: (No septic taonk or seepage pit permitted if public sewer i<s.ovailahle within 200 feet,) <br /> SEPTIC TANK Size...._��.�.X. `�"r.� <br /> PACKAGE TREATMENT { } } z Liquid Depth <br /> p� ..� � l Type Q -- . ---- --------` <br /> Ca acct 7.@.t1 Z.�. T e!'..�.�.�.�__ Material CanCr-�C. : No. Compartments: <br /> D'istonce{to.?nearer : Well. .Foundation ...L(7.�. Prop, Line .- ._._ .. <br /> LEACHING LINE : No. of LEnes ... . Len th of each line ;Total' Length ... ��. _-__.....i_. <br /> g <br /> D' 'Boz V S �a Zs, rc i <br /> 1 �' Type"'Filt&r M6teriol -. - Depth. -Filter Mater�61 ` .-_....1� .:......:...... ....... <br /> " <br /> I Distonce�-ta nearest: Well _.:�.Zo' 1"aundation <br /> I <br /> l PIT RockiFiled, No SEEPAGE <br /> Water...Table Depth -­'8-0. _-- _-- ----------- ------ ...Rock.'Size.., <br /> . . . .:.a.b: e?- <br /> la-04..`.. <br /> . <br /> _ o Prop.'Li ......F-Distance to nearest: Wellt tion . <br /> REPAIR/ADDITION lPrev. Sanitation Permit# .._ ------- ............ Date EJ <br /> Septic Tank (Specify Requirements) ._...... ........ .. r __ ............. <br /> Disposal Field (Specify. Requirements) •------ ... ---- -- ...... = . ...."--.. --"...-- <br /> ...................... ........ ................... ---------............. ..-..---------•-- . <br /> _- ......................................................................... -----------------__.._.__._.._. <br /> (Draw existing and Vie, uirecl:addition on reverse side) <br /> I hereby certify that I have prepared this application and thof the work will :be'done iris accorddneW with San Joaquin <br /> County Ordinances, State Laws; and Rules and Regulations of the Sart Joaquin Loral Health DistrietFloins`evrner or Iicen- <br /> sed agents signature certifies the following:: �{ <br /> k "1 certify that in the per#ormance,06 the work for which this permit is issued, I shatl net.employ any�p n in such manner �t <br /> p as to becoe subject-t* Workman s Co ensation laws oP California. ' <br /> f <br /> g . .. O <br /> Signed wner <br /> . .. <br /> BY .... .... .................. .............•----..-..------------ ._...... Titie . .:..-. ....: <br /> . ; <br /> (If other than, owner) i <br /> FOR.DEPARTMENT',USE ONLY <br /> APPLICATION ACCEPTED BY: .._... .. j'd `. ... ..-, 1, _ DATE <br /> BUILDING, PERMIT ISSUED ..... '-� <br /> �. .. .._..._.�. <br /> •��e% �ADDITIONAL COMMENTS :- .. . �r.�... .s. . <br /> _ _...,C.4.: <br /> _ <br /> .......... - <br /> ----------------- --------.........._..._.:... <br /> ---- ....... .............. . <br /> Final Inspection by: .._.._... t7 ' ' ' Date . _ � ._........ <br /> ._ . .__. <br /> . l� <br /> r — <br /> SAN JOAQUINLOCAL HEALTH rDISTRICT_ <br /> w. <br /> o <br /> H. 13 24 1-'68 Rev. 5M � <br />