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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit� N o.70- <br /> -------- ----------------------------- (Complete in Triplicate) <br /> ------------------ <br /> -—------------------------ ------- 1-_____ This Permit Expires I Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit 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 /> JOB ADDRESS/LOCATI <br /> --------CENSUS TRACT -------------- <br /> Owner's' Name ------ 5 olo_�_15�------ ------------------------------------------------------Phone <br /> Address ------------------ city <br /> --------------------�;---------------------------- <br /> Contractor's Name -------Z-7 c- - - <br /> ------- -4--------License Phone AK�47,�_ <br /> P-7 <br /> Installation will serve: -Residence )(Apartment Housef] Commercial :[]Trailer Court <br /> Motel 0 Other <br /> Number of living units:.__._______ Number. of bedrooms 2-------Garba.ge Grinder-----.---- Lot Size 3 <br /> Water Supply: Public System and name --------------------------------------------------------------------------- ----—-- ,-------------Private <br /> Character of soil to a depth of 3 feet: Sand [] Silt 0 Ckay F❑-1 Peat❑ Sandy Loam ❑ Clay Loanj�K, <br /> ' Hardpan.D Adobe-E.—Fill-M'aterial-----_.-----:-Ifes,type-i------------- ------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit pernriitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f ] SEPTIC TANK Size____-- - -- Liquid Depth <br /> K, --------------------- %531 <br /> Capacity Type 41_�na,�k mat" <br /> ------ No. Compartments ___.;R+_____.__..__ i <br /> Distance <br /> ----;R+_----------- <br /> Distance to nearest. Well ----Foundation ------ Prop. Line -------Is----------- <br /> I <br /> LEACHING LINE No. of Lines ------?�-------------- Lengthk of each line_____&P----------------- Total Length <br /> 'D' Box ...1-------- Type filter Material 4140--,A <br /> ___Depth Filter Material ---- ---------- <br /> Diitb'6c—e to`neareff.­W 11 <br /> (? —'Founddt ion Z-__ <br /> Depth -------------------- Diameter ----------------- Number ---------------------------- Rock Filled Yes F No .0 <br /> SEEPAGE PIT 27 <br /> Water Table Depth ----------------------- -----------_-----------Rock Size <br /> Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ----------- ---------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -----------------I-------- ------------------ Date t <br /> Septic Tank (Specify Requirements) -------- ------------------------------------- -------------------------------------- <br /> Disposal Field (Specify Requirements) -------- ----- - -- ------- 2- <br /> ---------- I '. ---- - ------- -- ------ <br /> ------------------------------------------------------ --------------------- <br /> ----------- --------------------------------------------- ------------------------ <br /> ---------------------------------- <br /> ----------- --------------------------------------- ------ <br /> ---------------- ------------- ------------------------------------------ 4 <br /> raw bxisti"ng—a n-d-req6ired addifl-on -on r��_e`rs_e: side) <br /> I hereby certify that 1—haive 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 lice"- <br /> sed agents signature certifies the following: <br /> "I certify that in'the P rf Vor n,�n c e of the work-for whit his permit is.issued, I shall not employ any person in such manner <br /> a <br /> as to become subject t: Tor an <br /> s Comliepvdlon s f California." -a <br /> Signed ---------------------------- t <br /> By -------------------------------------------------------------------- —- --------- ------ Title <br /> (If 6ther than owner) ----------------------------------- <br /> c his permit <br /> n f Calif <br /> . . .. .. .... .. . <br /> FOR DEPARTMENT US LY <br /> APPLICATION ACCEPTED By - ------------------------ <br /> . .... ..... ... <br /> ------------ --------------------------------------- -------- ------------ - ----------------------- ---DATE <br /> BUILDING PERMIT ISSUED . DATE <br /> ADDITIONALCOMMENTS ------------------ ----------------------------------- -------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ - ------ - ---- --- <br /> -------------- ------------------------------------------------------------------- ------------------------------------------------------------------------------------- <br /> - ------------------------------------------------------------------------------------------------------------ ------------------ - ------------------------------ <br /> Final Inspection by: ---------------------------------------------------------------------- ------- --- --- - <br /> ------------------Date ---- <br /> SAN JOAQUIN LOCAL HEALTH&ISTRICT <br /> 9 1-'68 Rev. 5M <br />