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FOR OFFICE: USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ........................................... Permit No. ...... 5........77 <br /> ;Complete in Triplicate) <br /> ............... .................... <br /> ....................... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health,District forts permit to construct and install the work herein <br /> described. This application is made incompliance with County Ordinance No. 549 and existing Rules and Regulations: w <br /> JOB ADDRESS/LOCATION a 1. - 1 ....._.. ............................CENSUS TRACT ......_._•.. ...... {� <br /> Owner's Name ..... ,c..... .; '- -•--•.......................................................••-----._.........._...._.....Phone .................................... <br /> r j� I <br /> Address .-.......__�7-l.'.> �....--•--------------•-------------- ... ...---•--...........---••.. City - - .................--- <br /> ........----............ . <br /> Contractor's Name ...,/ 1 :.._;e T �'------ -------•------••............License # i9,71-47,4YPhone OW *_n?h ...... <br /> Installation will serve., tResidence ZApartment House] Commercial:[DTrailer Court ❑, <br /> J Motel ❑Other,.....................................•••... f*� <br /> Aul <br /> Number of living units .... Number of bedrooms:......Garbage Grinder rte._. Loi Size .. , '` C................... <br /> Water Supply: Public System and name F Private <br /> Character <br /> ------------------•--......- ---•- •...__.......----- --- <br /> Character of soil to a depth of 3 feet: Sand 0 Silt[] Clay ❑ Peat❑ ,,Sandy Loam 0,-'.Clby Loam Of <br /> Hardpan ❑ Adobe C] Fill Material . . &f es,-typer <br /> {Piot plan, showing size of lot location of system in relation to wells, buildings', ec. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if publE�ewaei is available within 200feet,) <br /> PACKAGE TREATMENT [ ) SEPTIC TANK SEze. , ��d , � -------------------- Liquid Depth'7�-----•--•-••------- <br /> e i t L, <br /> �' 4._Material.[.� :..... No. Compartments Capacity 1e , Type P ' <br /> Distance to nearest: Well --- .f.__....:............Foundation --- --------- Prop. Line ..jv......... <br /> LEACHING LINE No. of Lines ....-:--------------- Length/of each line.20..................... Total_ Length 07.4W................. i <br /> •D' Box ._ Type FElter'MateJrIbl/,6ee ...Depth 'Filter Material "---------------- _ --_-.___._ <br /> � w ) o � <br /> Distance to nearest: Well -. p......_._... Foundation ..,/ .............. Property Line Wil. ._.............. <br /> SEEPAGE PIT [ ) Depth ....................;Diameter".'........,...... ..Number ............................ stock Filled Yes ❑ No (:3 . <br /> Water Table Depth _ ' Rock Size <br /> Distance to nearest: Well ....Foundation ..... Prop. Line 0 ' <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...................... ........... .......... Date <br /> Septic Tank (Specify Requirements) .............. ---.-----------------------•----•-----•--•-•---•-••-........................._..................._.---...---- ---- 1 # <br /> DisposalField (Specify Requirements) .......................:.........•........................................•......................................................... i <br /> r a <br /> (Draw existing and rec{uired 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 ::------4 . ;title ... '?( ........................................ <br /> (If er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------------1 MAI'- -- ---•....I............................................... DATE ........ ".�' ......_...... i <br /> BUILDING PERMIT ISSUED ........ ..... ...... .:DATE , <br /> ADDITIONAL COMMENTS <br /> ----------------------- �� <br /> ---------------- <br /> :....._... = :._... l: . <br /> �.�:. . . <br /> Final Ins pectlo-� ._nom!' - r � f''- ._.... ,; � E! 1 `' ...._....... Date ; ' ..................................- <br /> . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I 3 24 <br /> e u -7 /7r1 1 u <br />