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FOR OFFICE USE: <br /> ` APPLICATION'FOR SANITATION PERMIT L <br /> Permit No. __7 _------`--__ <br /> (Complete in Triplicate) <br /> ------------------------------------------ c� <br /> Date Issued <br /> This Permit Expires 1 Year From Date issued i <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 Regulations: <br /> - �ffl - T <br /> . ': ENSUS-­CEN <br /> JOB_ADDvSSLOCATION " ----' y <br /> Owner'sare1® - ----- -------------------------------------- --------_-- -------Phone .... <br /> Address ------ -------------------------------------- City -----------------------------------;-------- i <br /> Contractor's Name ------ -------- License ------------- Phoney <br /> ------ <br /> Installation will serve: Residence X Apartment House❑ Commercial ❑Trailer C urt ❑ ` <br /> EMotel ❑ Other ---------`---- ------------- \ ; <br /> Number of living units:--- Nu.rnber of bedrooms -J--_-'Garbage Grinder _.__----_.__`Lot Size _ __ ------------ <br /> __ <br /> — r — 1 <br /> Water Supply: Public System and name ----- T------------------------------------------------------- ------------------------------ <br /> Clay <br /> ----------------------- =- ' Private <br /> Character of soil to a depth of 3 feet.. Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type _________------------ ---- <br /> (Plat}plan, showing size o�kof I-ration of system in relation to wells, buildings, etc. must be placed on}reverse side.) ► <br /> NEW,INSTALLATION:_ (No sepfic itank or seepage pit permitted if public sewer is available within 200 feet,) O <br /> PACKAGE TREATMENT [ SEPTICTANK'[q Size______,_ ` Liquid Depth ----- ........... V <br /> - --W�" n -Ca acity /40Q-----TYPe ---- Material � No. Compartms --,-._ <br /> ------ <br /> Distance <br /> to nearest: Well ___! 45-D-----------------Foundation ----------- Prop. Line ___ _____,__ <br /> LEACHING LINE ' No:-of Lines _------I -______.____ Length of each line__,______�,W--- ---- Total Length <br /> l � �t f F 1 " <br /> at YP -- P 1 ---------/_ ------------ ----------- <br /> I <br /> -----v` - f <br /> -� <br /> t �Distance�to nearest: Weller /4rQ Foundation t Filter sten Property Line_ ___��_ =.-._-- <br /> D"' Sox _ <br /> Y F ! Rock Filled Yes No <br /> SEEPAGE PIT' , Depth --_ r ------- Diameter - ------ Number -----___--- ------------- <br /> i 10, <br /> Water Table Depth 7Q--------------------------Rock Size ------------------•------------- <br /> ----------------Foundation - Prop. Line <br /> REPAIR/ADDITION(Pr'ev. Sanitation Permit# ____________ _ -----} r �� <br /> Distance to nearest: Well •l <br /> ` � I Date <br /> , f <br /> ptic Tank {Specify Requi'rements --- t-------- d cx --------------- -----------------------------------------•-----------------•-o-.----- <br /> Disposal Feld (Specify Requirements) ---------------l_7�___--- ___ _ _ _ _� <br /> ------------------- ---- - <br /> ------- <br /> -------- ----------- -------------------------- ------ <br /> ---------------------------------------------- - - -- <br /> i (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 .loaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Iliien- 1 <br /> sed o'gents 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.toibecome subject to Workman's Compensation laws of California." <br /> I t <br /> Signed --------------------------------- --------'-------------------------------------- Owner <br /> ------ ------ <br /> k- BY --- --- --------- ------------------ -Title ------ ----------- ---------------------------- ---- ----- ------------ <br /> - ---------- -- - - - <br /> (If other than owner) <br /> R .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY //;-- - -- ----- ------------------------------------ ----------------------- DATE ��--•--------- <br /> BUILDING PERMIT ISSUED ____ _. ---���-p. i� <br /> --------- ------------------------ ------------------ -----------,_DATE -------------•------------------------------ <br /> ADDITIONALCOMMENTS _ -------------- -- -- ----------- ---------------- ---------------- ------------------------------------------- <br /> frj <br /> • -------- ---------------------- <br /> -- ---- - - - --- <br /> -- _, w_ <br /> ._ <br /> FinalInspection by: ---- ----- --- - -- - ---------------------------------•------------------------------- -------Date <br /> ;� SA JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Re . 5M <br />