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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT <br /> {Complete in Triplicate) Permit No. . <br /> .............. .............. <br /> ..___.... ... This Permit Expires 1 Year From Date Issued Date Issued Zld. y..._.. G <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 5ounty Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION 1 ,J�-.. ----- ----- -------------'0 ��. .. ........,..- -.......CENSUS TRACT ..__......_. ............. <br /> 1 Owner's Name .CT'... .. ...........��nr..... .------.-. `� ,.. .. G�.. .....Q.._. Phone .................................... <br /> Address : -!"J....................----. - City _.. ---- ................................................... <br /> Contractor's Nome . ?..f. .��`....�--- -------- License # .lL� �7. Phone <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other <br /> Number of living units:.. ....... . Number of bedrooms --.,3..Garbage Grinder ............ Lot Size -------...------._.......... ...... <br /> Water Supply: Public System and name .................................... ............ ..........................-............. --------------------Private <br /> Character of soil to a depth of 3 feet: Sand V <br /> ilt❑ Clay ❑ Peat E] Sandy Loam E] Clay Loam ❑ <br /> Hardpan Adobe ❑ Fill Material _._._. ,.... If yes, type ........ _ ...... ... ... . <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 se;7 ge pit permitted if-public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ } SEPTIC TANK- Size.. _. .// -l�./ .�.-... Liquid Depth ... f .. <br /> Capacity Q _. Type No. Compartments _.v........... <br /> Distance to nearest: Well ... ----------Foundation ...1_0_. .... Prop. Line ..5-J ...... <br /> LEACHING LINE [)'� No. of Lines - `j.,L&ngth of each line ... Total Length ...�. .__P....... <br /> 'D' Box .. ) Type Filter Material -..._.$...._Depth Filter Material .....).5--j., ................_....._rn <br /> Distance to nearest: Well ........!3.aJ Foundation P—_1-1 . Property Line ... ._/ �...._ <br /> ( p j�' P —` . .... Rock Filled Yes No[J Q(o <br /> SEEPAGE PIT Depth Diameter �.�.�_ Number ..._.. ..... .... <br /> . <br /> Water Table Depth ------ 12-0------- Size ..�._..�.�--rte..-----• _ <br /> Distance to nearest: Well . ...--J-..U.0--.Irk ____,__Foundation ..... .4b_.I'4--- Prop. Line ....... ., .:.....!d <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- _. ........ ..................... Date ..................................) S <br /> SepticTank (Specify Requirements) .-- ---- --------- ----------------- -------------•--••--------.- -------------------------- . .................... ------ ......... <br /> Disposal Field {Specify Requirements) ------------ --••--. ------------------........-- . ....... . ............ ------------...-_------- <br /> .......... .... ------ ............................. ................................ <br /> (Draw existing and required addition 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 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 Compensation laws of California." <br /> Signed .:.. . .... . .... .. . ... ... Owner <br /> By .B ............ <br /> . .. . . . ...............;/1.r+t.E�. - - ...�... - ---. _.. Title .. .. c<v_.. <br /> (if othe hon owner) <br /> FOR DEP RTMENT USE ONLY _ <br /> APPLICATION ACCEPTED BY . <br /> BUILDING PERMIT ISSUED ..... . . ---.---- <br /> ADDITIONALCOMMENTS . ... -------------- ­---------------- ....... . ._.,-_..., --.. .................. ........._..._..-- ......-------- <br /> .. ....._._... - <br /> .............. ---•-- .. .......... ---................. w - .................. <br /> ' g� Y .. ----------- <br /> Y-,O-...... . .. <br /> Final Inspection by: ..---�°-'---(h'----r --- - Date . '- ---.. ._...- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> a 1^. <br /> 13 24 7.1.72 334:: <br /> E. H. 1-'68 Rev. 5M _ - _ __ - - <br />