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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No: -4�', <br /> (Complete in Triplicate) � f <br /> ------------------------------------- <br /> Date Issued <br /> 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 application is made;in compliance vwith?County Ordinance No. 549 and existing Rules and Regulations: <br /> f L,� <br /> ---------- CENSUS TRACT -------------------------- <br /> JOB AQDRESS/LOAON _ f3TL - 0 �---- � � � <br /> Owner's Name ----- ------ --------------------------------- --------------Phone d- ------------ ----•-�-- <br /> ---- <br /> y 2t-1 <br /> - � cit <br /> ---------------------------------- <br /> -Address ---- Phone------"License - " -------- <br /> -- <br /> Contractor`s Name ----- P <br /> - <br /> �IzlInstallation will serve Residence ( artment## House Commercial ❑Trailer Court i❑ <br /> i Motel ❑ Others k ---------------------- <br /> Number <br /> --------------- ---- <br /> # r ` .Garba y <br /> Number of living units:--- Number of bedrooms -1 _____ Garbage Grinder ��-- Lot Size --_ <br /> t __-____Private <br /> Water Supply: Public System and name -------------- ----t-•-- ---------------- - - --------------------------- <br /> Character of soil to a Ilepth of 3 feet Sand'[�ilt❑ Gay ❑ Peat❑ Sandy Loam 0 Clay Loam..❑ <br /> Ct l <br /> Wdrd�ian-"❑ Adobe ❑ Fill Material ----- ------ If yes, type ---------------------------- <br /> [Plot plan, showing size of lot, location of system in elation to wells, buildings, etc. must be placed on reverse side.} <br /> 41 <br /> NEW INSTALLATION: (No septicaank or seepage it permitted if public sew is avaif�ble within 200 feet,) <br /> I <br /> SEPTIC TANK' ,� / Size__ �/T:_A_)r------------- Liquid Depth _.T.�--------------- <br /> PACKAGE TREATMENT [ ] [�1' � # ----fes-- -- <br /> Capacity/,Z*�------ Type ---�f} _ Material J�� r No. Compartments -- _-....-=---- <br /> I �j <br /> Distance to nearest. Well _ Wit---------------------Foundation _,�Q------------ Pr, Linese -..:-f--- <br /> I { ----- Total Length , <br /> i <br /> LEACHING LINE [�} No. of Lines _ __ - + Length of each line.___. _ --- g <br /> 'D' Box - ---- Type Filter�Material G-------Depth Filter Material _/9--- --------•��-------- <br /> } , <br /> Distance to nearest: Well -- - ------------ Foundation -- ------------ --- Property Line ________.-.-------•`-•-• <br /> t <br /> SEEPAGE PIT [ ] I Depth -------------------- Diameter }t --- Number __.------------------- <br /> ------ Rock filled Yes C) 1nlo 10 <br /> Water Table Depth 'p'" -------Rock Size ----------------------•--------- <br /> `� - i _.":- `s ff <br /> -�Distance�to,n.earest: VelI --------------------------------------- <br /> foundation -------------------- Prop. Line -----•-- ------------- <br /> l <br /> REPAIR/ADVITiON{Prev. Sarntafion1 Permii'�#`...---•-•-=--=-=----- ----------- ------ Date -------------.-------------- <br /> •-----I <br /> Septic Tank (Specify Requirements) ----------------------- _..'�. .- i <br /> 4 *Disposal Field (Specify Requirements) -------------- ----- =-'----`-`-------------------- - •�=-.- --- <br /> - -------- - <br /> w1I <br /> 0 ----U--------------------------------------------------------------------------­­---------------------------------------- <br /> -------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> f; <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--a ncl--Regul6ions--of-the-Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the ; <br /> for which this permit is issued,! shall not employ any person in such manner <br /> as to become subject to Workman's Cam nsation laws of California.".0 <br /> Signe --------- ------------------------------- Owner <br /> ] ------------------------------ <br /> � ' '= Title /it'f�% ' fr"-1�., A !✓- <br /> BY ,_: ------ -- <br /> -- - --------------- <br /> (If other than owner] <br /> FOR—DEPARTMENT—USE--ONLYW <br /> APPLICATION ACCEPTED BY ....................... <br /> - -------------- ---- ................................. DATE ----------------- <br /> BUILDINGPERMIT ISSUED ---------- t-------------------------------------------------------------- -------------------------------DATE -------------------------- ------------ <br />! ADDITIONAL COMMENTS .---- ------'-------------------------------------------- - J. <br /> ----------o° ' <br /> ------------------------------------------------------ --------------------- l��.i-�_ -� <br /> ------------------------------------------- <br /> -------------------------- <br /> ------------ ------------------ -- s <br /> -- __ /J _. ----- ----- Date � r�f�-G '_ <br /> --y. --- ---- F ------------ <br /> ---------------- <br /> Final Inspection b a -- �",.______�- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />