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FOR OFFICE USE: APPLICATION � 11 Sip <br /> FOR SANITATION PERMIT �- <br /> ,...... '7 ....................... <br /> Permit No. ... �_`�i- <br /> (Complete in Triplicates <br /> qA <br /> ..................................... This Permit Expires I Year From Date Issued <br /> Date Issued _.6 r. •-..7. <br /> Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATION ...-,".'SS... :.__ +. Ff#.'7!. .7` .................................. ......CENSUS TRACT ........_.._._. .......... <br /> Owner's Name ............... :U= .. � Y -----------------•----..._....•--•- Phane <br /> •--•- <br /> Address S f1 r-t E SN ._ <br /> _.............. • R ......... <br /> .-------------------------------------•• City .5?m 't----••---- <br /> -••.....-------•----••-•..................... <br /> Contractor's Name O <br /> ...License # .... Phone .. �... b 7.. <br /> Installation will serve: Residence Z Apartment House F❑ Commercial ❑Traller Court C] <br /> Motel ❑ Other ............................................ .- , <br /> Number of living units:......f.... Number of bedrooms .A-_---Garbage Grinder ............ Lot Size ...6 0.x__�a�_ . <br /> --•.............. <br /> Water Supply: Public System and name ... -------------------------------------------.....................................................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam i[] Clay Loam ❑ <br /> Hardpan ❑ Adobe (k 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 seepage pit permitted if public sewer is available within 200 feet,) �{ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------------- _--------------._....-- Liquid Depth .......................... G� <br /> Capacity ----•--------------- Type -------•------------ Material ..................... No. Compartments ................... <br /> Distance to nearest: Well ......................... .........Foundation - Prop. Line <br /> LEACHING LINT: [ ] No. of Lines ------------------------ Length of each line. '........----_..._........ <br /> Total Length .... ...................... <br /> 'D' Box _........... Type Filter Material ....................Depth Filter Material ._.__._.__......................._. ........ <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ..........._............ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ................ Number ............................ Rock Filled Yes ❑ No Q <br /> Water Table Depth ..................................-.......-------Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation ..... Prop. line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) <br /> Septic Tank (Specify Requirements) ..... Ha-j� �---:nJp s Rigff-------•------- <br /> Disposal Field (Specify Requirements) ------------------------------• ---•------------------ -------------------------- ................................................... <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ..........................................................................................................-•------....-----------------------------..._...---.....---..._............-------•----_...-- <br /> (Draw existing and required addition on reverse side) <br /> 1 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 subjecti0n <br /> kman's Compensation laws of California." <br /> Signed .._._.. ..................... Owner <br /> BY ------------ --- - lCl_%. . Title .. ....._......._...... .._..._ .._._�_ <br /> (If othewner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...C,,:...... --•... ------- =.Lt'1�....... ©ATE .. .�. ........... <br /> BUILDINGPERMIT ISSUED .......-••..............•..... ---.....-•----------------.....------------.DATE --•--.._......._..._... ................... <br /> ADDITIONALCOMMENTS .................................•-------•--••--•------•-•---....._---.........._................---..............................:....._......_........---... <br /> ........................................... -.........................................................----._.. --•--•-_...._.. .. .. . ............... <br /> Date ...._. <br /> Final Inspection by: . ........................... --=�--------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 24 1-'68 Rev. 5M 7/72314 <br />