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FOR OFFICE USE: <br /> APPLICATION FOR-SANITATION PERMIT <br /> J "h9. = ----.`P------ Permit No,.------------------------ <br /> (Complete in Triplicate) <br /> ------------------------------------------------------------------------- <br /> " Date Issued��-_1�-� <br /> This Permit Expires 1 Year From Date - <br /> ----_--------------------------------_-------- ---_ <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> / <br /> '-------- <br /> ---CENSUS TRACT -------------------------- <br /> JOB ADDRESS/LOCATION <br /> Owner's Name .- P __�^I..J- / T---------------------------------^=------- ----------------------------Phone ------ ---------------• - .-------- <br /> Address = CitfJ ---------------------------------- <br /> '_/ 7 ------- ------ ------- - ----.---------- ,v, j <br /> ;. l Trailer Covet rr2 <br /> Contractor'sName ------ �- - f a ems------ - ---------- ❑ -_ Phone <br /> ______-License #/_�l�s?� <br /> Installation will�erve: Residence 04 Apartment House❑ Commercial ❑ <br /> Motel Other -------------- <br /> ❑ -----'------------------------- <br /> Number of bedrooms'--Z------Garbage Grinder Q.- Lot Size �'_� —I? - -'-• <br /> r, <br /> Number of living units:.._ :___._ <br /> t �, P; t � Sand Loam <br /> Water Supply. Public Sys em and-name ----------- ----------------------------------------- -----------------Private <br /> " + k <br /> Character of soil to a d pth of 3 f det: Sand❑ Silt❑ Clay ❑ ❑ y �❑: Clay Loam.E] <br /> i <br /> AAdobe <br /> Hardpan E] '?i Fill Material ------------ If yes, type f_------------------------ <br /> lot plan, sho wi g si� of loth 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 feet) <br /> i' <br /> ,PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size------------------------ <br /> - ---------------------: -- Liquid Depth _._--------------------_-- <br /> t Capacity '------------------- Type -------------------- Material T------- No. Compartments <br /> W Distan a to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --------......--_------ <br /> + <br /> LEACHING LINE-, L l No. of Lines ------------------------ Length.of each line- ------ ----------------- Total Length ---------------------.­­­ <br /> 'D' <br /> .__ ._'D' Box -- --------- Type Filter Material ____________________Depth, Filter Material ------------------------------.`.J;Z- ........ <br /> v r <br /> Distance to nearest: Well ________________________ Foundation,",- ------------ Property Line. __________:..___........ <br /> SEEPAGE PIT [ Depth' _A---------------- Diameter ________________ Number --------- ---- -------------- Rock Filled Yes ❑ No .0 <br /> f Water,Table Depth --------------------------------------------- ---Rock Size ------.-----------------------_-- <br /> Distance to nearest: Well -----------------------------------------Foundation! -------------------- Prop.,Line ---.---_.._------ <br /> REPAIR/ADDITION(.Pfev. Sanitation Permit# _________________________ <br /> ------------------ Date --------------------------------- <br /> Septic Tank (Specify Requirements) --------------N-. ` / -' - r <br /> Disposal Field (Specify fy� Requirements) frf- ---•:-t���__��_ ���----�/�=-�-1-�-----�3.-"�-���'r <br /> M1t J <br /> 4 ------ --- -------I ------------------=-=------------------------------------------ -------- t,F <br /> ------------------------ - -------- -------- <br /> {Draw existip and required additib n 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 /> "I <br /> ollowing- <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 Compensatiln laws of California.' <br /> Signed ----_--------- F ,....� »� .�---� <br /> --------- - ---------------- - t Owner <br /> B ' /y.. _ ...-_ Title ------------------------------- <br /> By _ ! <br /> l (If other than owner) ,� <br /> [ FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY# -Dir--- - --- ----------------------Ky---------------------------------------------- DATE _J2-Ar -7--(0-1----------- <br /> BUILDINGPERMIT ISSUED --- R ==--------------------------------- --------------------- ----------- ---------------DATE ---- ------------------------------------- <br /> ADDITIONAL COMMENTS ___f----------------------------- <br /> --------- --------- `----- --------------- ------------------------------------ ----------------------------- <br /> r - ---- -----------------------;-------------------------------------------------------------------------------------------------� <br /> -------------------- ---------------------------------------------------------------------------------------------- -- <br /> ----------------- <br /> ------------ <br /> - <br /> -------------------------------=------------------------ ---------------------------- - -- <br /> - _ - <br /> Final Inspection by 0 --- --------------------- ---- - - ---------------------Date --- -- --� --1� --�--- <br /> I SAN JOAQUIN LOCAL HEALTH DISTRICT ' <br /> E. H. 9 1-'68 Rev. 5M <br />