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� A <br /> FOR OFFICE USE: - <br /> 1. APPLICATION P4}R SANITATION PERMIT 7a-11513 <br /> --------- '" Permit No- -------------- <br /> (Complete in Triplicate) <br /> f -------------------- ----------- <br /> Date Issued <br /> -------------_____--------------------------------I This Permit Expires i Year from !]ate 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 Regulafaons: <br /> JOB ADDRES5lLOCATlO / ------- �-------CENSUS TRACT <br /> Owner's Name -----_-. .._ <br /> ---- ------ ------------------------------------ -------Phone ----- <br /> f ' - `1 �- . itYAddress ------------------ - ---� License <br /> n�se # PhoneContractor's Name �f <br /> -- _ <br /> Installation <br /> will serve: Residence Apartment House Corhmercia! [-]Trailer Court <br /> Motel ❑ Other --------------------- --------------- .. <br /> Number of living units:__:_!___-__ Number of be rooms ___3-----Garbage Gr' der- `___ Lot Size ------------------------------------ <br /> Water Supply: Public System and name --- ±----------- -------- ----------------------------------------=-----Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ ' Peat ❑ Sandy Loam' Clay Loam ❑ <br /> Hardpan E]',. 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 an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V <br /> PACKAGE TREATMENTI I SEPTIC TANK:X Size---,& _- _ _ _ a_-------- Liquid Depth - -- ------------------- <br /> Capac;ty,JV&V_(;/f4,TYPeIOAI-c_� Material_____________ _ __ o. Compartments ---------............. <br /> '♦ / r <br /> Distance to nearest: Wel! -________ ____________Foundation ----1 d__/_.__-__- Prop. Line _-__-. <br /> LEACHING LINE No. of Lines ___�Z---------------- Length of each line-----���-------- Total Length/1YA_�r__---.-_ <br /> D' Box --- --- Type Filter Material _ ---Depth Depth Filter Material __Z-PF--------------------------------- <br /> Distance <br /> !-------------------------- <br /> Distance to nearest: Well _-�------------ Foundation -_6a_---__-------_ Property Line Diameter -;7------__ Number -------------------- <br /> SEEPAGE PIT �'' Depth __ �- x-_. 3 /.---_ Z ------- Rock Filled Yes No <br /> Water Table Depth -----------------------------Rock Size ---�--- ---------------- _ <br /> Distance to nearest: Well ------ — ------4�' <br /> ------------------ --------- ----- Prop. Line -. --.._ _..._... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------ Date -_-----__---____.__---------------) <br /> Septic Tank (Specify Requirements) -------- ---------- ---------------------------------------------------------------------------- ------------------------------- <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------ ------------------- -- --------------------------------------- ------------------------------------------ ------------------------ <br /> -4.7 <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, Horne owner or licen- <br /> sed agents signature certifies the following: r, <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 /> qTitle ----------� ----- ----- -- ------------------------- <br /> BY ------------------------- ------ - --- -- --- ----- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> f APPLICATION ACCEPTED Y - DATE . �'---------------- <br /> BUILDING PERMIT ISSUED---------------- ` --------------------- ---DATE --------------------------- <br /> ADDITIONALCOMMENTS ------------------ ------------------------------------------------ ----- ---- ------------- ----------------------------------------------------------------- <br /> ---------------------------------------------•-------------------- --------------------------------------------------------------------------------------- - - <br /> ----------------------------------------------------------- <br /> --- ------------------------- - ----- <br /> --------------------------------------------------- ---------------------------------------------------------- <br />' ----------------------------------------- ------ <br /> --------------------------------------------------------------------------- <br /> Final Inspection by- 7 -------------•----------- Date / <br /> SAN JOAQUIN LOCAL HEALTH 1)1,6TRICT' <br /> E. H. 9 1-'b$ Rev. 5M <br />