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FOR OFFICE USE: <br /> LICATION POR SANITATION PERMIT <br /> -------------------------------------------------- Permit No: ...7�.`- 32 <br /> (Complete'-fn Triplicate) <br /> ------------ <br /> Date Issued <br /> --------------------- his Permit Expires ] Year Prom Qate Issued -. ��� L <br /> Application is hereby made t e San Joaquin Local .Health1 iistrict for a.per to construct and install the work herein <br /> described. This application is ade in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ZJOB ADDRESS/LOCATION ------ -b- -- ------ -- CENSUS TRACT -------------------------- t <br /> CLIC_ o-------Phone "-- <br /> Owner's Name <br /> Address /6,3 <br /> - ---- -- -------- ----f`` City <br /> ``GG (� <br /> Contractor's Name -------------- - '::----._.License #! ] ------ Phone -7--66--?4 4-7. <br /> Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ❑ , <br /> Motel ❑Other -- ---- ------- ------------------------ <br /> Number of living units:----- ----- Number of bedrooms ___ -`_-__Garbage Grinder ------------ Lot Size -__-_ ?r - ----_- <br /> Water Supply: Public System and name--------------------------------------------------------------------------------------------------1- -•-•=...Private <br /> Character of soil to;a,depth of 3 feet: Sdnd'❑ Silt C] Clay ❑ Peat❑ Sandy Loam -El ,Clay Loam ❑ <br /> fE <br /> rr Hardpan ❑ _. ..Adobe_❑ 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;{'] Size:=----------------------------------_-________ Liquid Depth --------------------------- <br /> Capacity <br /> _- _------_-_-.---Capacity -'------------------ Type -____________------' Material---------------------- No. Compartments <br /> a Distanceto nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ..............__._---_- <br /> LEACHING LINE [ ]. No. of Lines_ ----------_--- -------- Length of each line---------------------------- Total Length -----------------------.-.-- _ <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material _--_------__.___-----_-__--_-_-_- <br /> Distance to nearest: Well-=-__- :_.�______________ Foundation ------------------------ Property Line. .__._--•------____._.-_- <br /> SEEPAGE PIT Depth -------------------- Diameters"----- --------- Number ---- ----------------------- Rock Filled Yes No <br /> �❑ . <br /> Water Table Depth ---'--- ----------------------- -Rock Size ---------------------------- --- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------_----------- <br /> REPAIR/APPITION(Prev. Sanitation Permit# *---------------------------------------- Date _---_--_-_--_--_-___---_--_-_-_--) <br /> SepticTank (Specify Requirements) ---------'------ ------ --------------------------------------------------------•-----------------------------< ----------------•-----••--- <br /> " r p� <br /> Disposal Field (Specify RequHements) --_�<G . ....�P--_-_--__--------------___--_��___X__- 't 1_ <br /> ----------------------------------------------------=-------- --------------------------------------------=- ------------------------- ------------------------------------------------------------------ <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 bp'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 shalt not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------------------- Owner_' <br /> BY -------------------S--C ---- Title <br /> ---- ------------------------------------------------------ <br /> (If other owner) <br /> -_ FOR bEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ -------•-------------------------------------•-- DATE ------ -a �-�7Z__ <br /> BUILDING PERMIT ISSUED ---------------------------------------------------------- - -----DATE -------------------------------------------- <br /> ADDITIONAL <br /> ------------------------------------- ----ADDITIONAL COMMENTS ----- ---------------------------------- ---------------------•-------- -------------------------------------------------------------------•---------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- <br /> -e- r <br /> Final Inspection by-- -------------- -- ------------------Date ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />