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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> -------------- <br /> -- <br /> .. . .......... ------------------ ------- ----- (Complete in Triplicate) <br /> ---------- --------------------------------------------- , Date Issued <br /> --- This Permit Expires 1 Year From Date Issued <br /> Application is hereby'robde to the Son Joaquin Local Health District for a permit to construct and install the work-herein <br /> Zscribed. This applic`btic,6 is-,mdde-ih compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> --------- ---------.-CENSLIS TRACT -------------- <br /> ------------ <br /> JOB ADDRESS/LOCATI(X4. 74;---------- --------- - ------------ ---- <br /> 11; Z -------------- <br /> Owner's Name -------- - -------------------------------- -----------------------Phone ----------­-------_ <br /> ------------- City ---------------------------------------------------- <br /> ----- ------=------- . . ............ <br /> Address -------- -------- <br /> t"F <br /> ----License 0 --- Phone --_---------------------- <br /> -7----- ------ <br /> ----- --- -- <br /> Contractor's Name ------------- ---- <br /> Apartment House-F-1 Commercipl :E]Trailet Court <br /> Installation wilkserve, Residence L� <br /> Motel F-1 Other"------------------------------------------- <br /> 4,.urnber of living units:_- ----- Number of .bedrooms ---Garbalgq-'Grinder --------- Lot Size --------------------------------------- <br /> ater Supply: Public System and name ------------------------------- ---------------------- ------------------------------------------------- ------Privateo <br /> Character of soil to a depth of 3 feet: Sand'o silt❑ Clay E-] Peat E] - Sandy Loam -E] Clay Loam E] <br /> Hardpan Adobe F. J,ill-M*(itedal-------------- If yes, type ---------------------------- <br /> 4 it <br /> (Plot plan, showing size .!of lot, location of sys�t6m. 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 /> S Liquid Depth _Y_ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK -----------5.................. <br /> Capacity I Type(� Material No. Compartments ------ ........ <br /> Ist. Well ----------5-01 <br /> ce to nea <br /> Distan -----------------------Foundation _10............. Prop. Line ---- ---------- <br /> 'LEACHING LINE 3 No. of Lines ------- Length of each Fine-------1,00—/---------- Total Length ---- ---------- <br /> 'D' Box ----f_.__._ Type Filter Material _--_'Z_2-___ __Depth Filter Material --------- ---------------­-­------ <br /> Distance to nearest: well ............... Property Line ------------ <br /> f,�/ ------------ <br /> SEEPAGE PIT Depth -------a2 Diameter .. <br /> Number .. ..... le Rock Filled Yes 0 <br /> No 11 <br /> Water Table Depth ---------------- --------I-----------------Rock Size ---- --- <br /> - <br /> Distance to nearest, Well ---------- .......... ----------Foundation ------ -r-___ Prop. Line ----- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------•-----------------------) <br /> Septic Tank (Specify Rlquirements) ------------------------------------------------------------------------------------------------------------- ------------------------­- <br /> Disposal Field (Specify Requirements) ------------ ------------------------------------------------------------------------------------------------------- <br /> 11------------------------------------------i----------------------------------------------------------------------------------------------------------------------------------------I------------------------ <br /> I------- --------- -------------- --- ---11--------------------------------------I------------------------------I--------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> ii <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 /> :F <br /> II' <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 /> s to become subject to Workman' <br /> s-Campensation laws of California." <br /> J1 <br /> ICM <br /> --------- ------------- --------------- _6 ------------I Owner <br /> 0 B Title -------------- ----- ----------------------- <br /> i (If other than owner) <br /> iy ----------------------------------- ---------- FOR DEPARTMENT USE ONLY — <br /> 31- 2— <br /> kPPLICATION ACCEPTED"' BY -------------- ---------------------------------------, DATE S ----------- ------------------- <br /> ISUILDINGPERMIT ISSUED --•------------------------------------------------1---------------------------------- - --------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ----------------------------------------- ----------- -------------------------------------------------------------------------------------- ------------------ <br /> -------------------------------------------------------------------------------- <br /> ---------------------------------------:----------------------------------------------------------------------------------- ----------------- ------ <br /> ------------------- ----------------------------------------------------- ------------------- --------- <br /> -- ------- - ------ --- <br /> Final <br /> ------ ----------------------------------- -------------------- <br /> ------- ------- ----e--------- ---0 ------------- <br /> -------------------- ------------------ Date- <br /> bl---------- <br /> ---------------------------------------------------------- ------- <br /> inal Inspection by: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />