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.l <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .._................ / Permit No. S <br /> (Complete in Triplicate) <br /> .............................. <br /> [ � � Date Issued <br /> ....................................... This Permit Expires 1 Yea''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 with Count,�brdinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ... <br /> �� _�y4_ ........ ................. ...........CENSUS TRACT ................... <br /> Owner's Name ..............W i..._-...-.�!v tiz.� .. . -_.---.--,_-.�..----- � _..._ . Phone Z � <br /> Address - �.�S.. d...._... �: '.... City <br /> ........................................ <br /> / ! <br /> Contractor's Name l w - License # . 5.'0._. Phone . 6.6..-�f a7... <br /> Installation will serve: ResidenceApartment House❑ Commercial []Trailer Court <br /> ri . <br /> Motel ❑ Other --. •-----------------------_- <br /> Number <br /> ----------•------ <br /> r y l <br /> Number of living units:....-1.._,... Number ofAbedrooms .._---._Garbage Grinders,-- _... Lot Size .... ._-..��'c�L��—......._____•_-( rt <br /> Water Supply: Public System and-name _._...- -------------------------------------_:...._. '� <br /> PP Y� Y � _ --•'`-�•-,-'- -•-• ��..:..................�------------•---....Private <br /> Character of soil to a depth of 3tfeet. Sand❑ Silt[]Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe [] Fill'Material _._._...__ If yes, type -------___............. " <br /> [Plot plan, showing size of lot, location of system in relation`towells, buildings, etc. must.be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tonVor seepage pit permitted if,public. sewer is available within 200 feet,( <br /> PACKAGE TREATMENT [ } SEPTIC TANK SI e.....------ ....... j,� .,.___.__._.._`. - Liquid Depth ... <br /> Ir4:Q �7.[. r .No. Compartments <br /> Capacity f Type -AA..P._ Material- - - - P <br /> '`` r V �� p. _rr..... <br /> Distance to nearest? Well- . ... ._�.....__- __.___.Foundation _..._.�.`_.......... Pro line .. .... <br /> LEACHING LINE ] No. of Lines _ _ �._. Length of"ochine Total Length _._ ................ <br /> a 4 �y % <br /> 'D' Box ..L� T e Filter Material __ ___-Depth Filter Material .... .`8.............._�.............. <br /> Y P.. . <br /> Distance to nearest _Well ..._ Q-rte_.._ Foundation C1J-'f',.-- property Line -:' <br /> SEEPAGE PIT Depth _ :X Diametef,* .,;3....__._ Number .-_,__. -.. ...._._. Rock Filled Yes No Q <br /> Water Table Depth <br /> --------------------Ro <br /> Distance to nearest. Well _._- 1. ,--- -----------------Foundation _1..a..-------(Pr6p. Line ....5;_:f........ t <br /> REPAIR/ADDITION(Prev. Sanitation Permit-#-7­=n------Permit-# ------ ------- ---- -.: Date ----_-----•-•----- 1-----..-•---) <br /> Septic Tank (Specify Requirements) ........ --------------- r--_.--- .�7. -•--- -------------------- <br /> •---•-------•--- -•-- • .................. <br /> Disposal Field (8pecify Requirements) t I <br /> -F ............................ <br /> ___ # <br /> ` (Draw existingand,re uired addition on reverse side)°*. <br /> I hb"riby certify that I have prepared this application and that the work will be done iA%accordance with San Joaquin <br /> County Ordinances, State laws,` and Rules and (regulations of the San Joaquin Local Health District. Horne 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 Califortsier" <br /> Signed .:.... ............. .... .. . Owner <br /> ` <br /> BY -- Title . ............. ....... . ............_. <br /> (If oche t an owner) <br /> FOR EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE .... .�1..,7..� ......_._ <br /> �j <br /> BUILDING PERMIT ISSUED _.......-••--- .....................: •._.::_• ...__..v.. - ' DATE ...._......._ <br /> ADDITIONAL COMMENT _ _. ,�_'� � t - - <br /> K. s. . . - <br /> -----•---------- ----------------------- --------- <br /> --..................................... ..... .... ................................... .......... ,/ <br /> FinalInspection by: ..... ...... ... ........................... ........1 ..----- . ....... -•- ............ ate ..�.d.."`7`. ---- -----•--•-----•-- <br /> SA JOAQUIN LOCAL HEALTH.DISTRICT ;.._._. :. <br /> c u 13 r,a .. 7172 3 .K <br />