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---a•Fi OFFICE USE: �� <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. ... ..':. . <br /> _... (Complete in Triplicate) <br /> .. <br /> ....... .............. ..._._.I..._._....• .... � <br /> bate Issued ..,�....�.--•• <br /> �l-.- This Permit Expires 1 Year From 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 applicationis made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .�.:.. oi6"0•7:.-..'LCL ... . --- ,...J4. CENSUS TRACT ........ <br /> _.. .......:.....................Phone�>3,.._''kzp_ - <br /> Owner's Name <br /> ._ � ..................................... <br /> Address �� .._. City <br /> I Contractor's Name ----- •-- �.4:? t ... ....?-1 1 Y_..... <br /> License # '�'-- <br /> Installation will serve: Residence] Apartment House Commercial ❑Trailer Court 0 <br /> rrI motel ❑Other ------------------------_--- .............. <br /> Number of living units:.._.1.�._.._. Number of bedrooms .. ....Garbage Grinder ------------ Lot Size ....1-/ ...., <br /> Water Supply: Public System and name --------------------- ------ -.........._...... -----......-- Private <br /> Character of soil to a depth.of 3 feet: Sand n Silt❑ Clay ❑ Peat❑ Sandy Loam -0 Clay Loam 0 <br /> ---pp`- ��- e -----_-------------------- <br /> m <br /> _.--_----------- - -- <br /> (- Hardpan ❑ Adobe Fill Material ..__.......- if yes,typ - - <br /> I I <br /> I <br /> (Plot plan, showing size all lot, location of system in relation to wells, buildings, etc. must 11 be placed on reverse side.) <br /> NEW INSTALLATIONi iNo septic tank or seepage pit permitted if public sewer is available within 200 feet,] <br /> '�. <br /> PACKAGE TREATMENT [ ]i� SEPTIC TANK[ ] Size--------- -•••••--•••= .�................... Liquid Depth P .......................... <br /> - — Cgpaci.ty <br /> . Material....."............... No. Compartments --•--...__............� <br /> .................... Type --- ................ -. 0 <br /> Distance to nearest: Well ............................. --Foundation _7 .............. Prop. Line ................... 6 <br /> LEACHING LINE [ ] No. of Lines ------------------- ---- Length of each line^-....--........_...._.. Total Length ....._.. ................... 0 <br /> t J <br /> D�` Box .. .__..... Type Filter Matter�i. ................Depth Filter Material ---......--------•--......... . . - <br /> Distance to neare�t:'Well T '...._ '°' .. _.. 'Foundation _.......---------------- Property Line ........................ <br /> SEEPAGE PIT [ ) Depth Diameter ................ Number ----.-------_..•_. -: -.__.. Rock Filled Yes ❑ No �] <br /> • Water Table Depth ------------------------------------------------ <br /> Rock Size* :... <br /> - ....._.. k <br /> ' - � Foundation ..... Prop. Line -•-•---- <br /> Distance to nearest: Well .......................... � -•---••- ..........---- <br /> EPAIR DDITION(Prey. Sanitation Permit ------------------- ---- Dote ...__.......-..•-- .._........_.y <br /> Septic Tank (Specify Requirements) -•:- - -.. 1 <br /> Disposal Field (Specify. Re uirements) -seo. - '� """ ' ""'"" "" <br /> ... ................................................................ ----------------------------------------- -------------......................... ------.._.. ................... <br /> 1-..._.._=� - -.w.._-_:------•-- --- __-.-. _. . <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 iicen- <br /> sed agents signature certifies the following: ' <br /> "I certify that in the perfo mance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Wiarkman's Compensation laws of California." <br /> Signed ------- --.-._ ;. _..�.I ----------•...............•--............_ Owner �. <br /> B �N . Title ----- <br /> Y ----- ------ ---- ) <br /> (if of r ha"' owner) _. <br /> FOR DEPARTMENT SE LY <br /> APPLICATION ACCEPTED I�BY --------------------•- ------------ �. DATE .._.�C_ _ .. ......_...... <br /> BUILDING PERMIT ISSUED ....... ---------------.... .......... -••-.......__... .... ------ . ................-DATE •-.---------------------- -••--- <br /> r ADDITIONAL COMMENTS._ ...................................... . ......-.-----------------_.._.......--------- ....--•..................--. ...- <br /> II :..................................................................•--........---'--..._.._......----......----....._._'_'_'...........'_"__ <br /> .....................----------- <br /> ------------------------- <br /> .......................... - <br /> I� v __. -- -:;Z;;- - -------•' ................................. <br /> ....................................... ...............................................�_. •_.v- •_..1 <br /> II' .... <br /> ..........:.............................I .......................... ...... <br /> Final Inspection by: it �l ......Date ........ .. .. ..................•--- <br /> f ......----•••....--•- ---•-------------------•-•---------.......................... <br /> SAN JOAQUIN LOCAL HEALTH DI ICT CP <br /> E u 13 241_-An oe., SAA 7/72 3-M <br />