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FOR OFFICE USE: , <br /> i <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. --�----�-/--� <br /> (Complete in Triplicate) <br /> ..........I---------------------------------------------- <br /> i <br /> ------------ - ---------------- � <br /> ---- I ,This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the S:1n Joaquin Local Health District for a ,permit to construct and install the work herein <br /> described. This application i' made'm compliance with.County Ordinance No. 49 and existing Rules and Regulations: <br /> JOB ADDRESS/LOC� ATIO fir? - �7i � -------- -- --------- -----------------CENSUS TRACT -------------------------- <br /> �. 3 / <br /> Owner's Name --- ------ Phonei <br /> Address --tl.� C-- <br /> - ------ •----------------------------t� ,-----=-t: City. _------ --' ----- ---- <br /> -------- ---- - <br /> 7 %_ +: n <br /> Contractor s Name _.. ...��_�_ e9�/_�� _ _ �= _i± (__.License /-����- Phone <br /> Installation will serve: ' ResidenfeXApartment House'❑ Commercial ❑Trailer Court ;❑ , <br /> { ; Motel ❑ Other <br /> ----------------- <br /> I <br /> ; ,... <br /> Number of living units,.--/'-.-- Number of bedrooms vY___:__Garbage Grinde-'O-O_,Lot Size ------------ <br /> --WatWater <br /> er Supply: Public System'and nare ----------------------------------•---------------------=------------------------------------------------------Private <br /> I; <br /> Character of soil to a depth•of 3 feet: Sand'❑ Silt❑_ Clay E] _Peat E) Sandy Loam ❑ Clay Loamk <br /> Hardpan-E].._ Adobe'❑ Fill Material ------------ If yes,type ---------------------------- <br /> K� 9 r <br /> (Plot plan, showing size:of lot, location of system fin relation to wells, buildings, etc. must be placed on reverse side.) ` <br /> NEW INSTALLATION: {No .septic tank or seepage,pit--permitted.,if-pwblic sewer-is..available within 200 feet,} <br /> l l� . <br /> PACKAGE TREATMENT [ J SEPTIdJANK ( 4 ize lft �_____________i_ Liquid Depth _----___________ <br /> 3 <br /> --- <br /> Capacity/ �-____ Material ir- "----- No.. Compartments ..-.-•--• ------ <br /> 1"' s ' -'. <br /> ." Distance tonearest: 1JVel �_ _______ <br /> -----------------Foundation = ----------'- Prop. Line'-• <br /> '�N Box ei ----of------ - Length oaf each line._O- Total Length -----•--------:--- <br /> ------- <br /> 'LEACHING LINE No. o Line Type Filter Materiaj� Depth Filter Material/� -_--___-_ <br /> Dista ce to!nearest: Well __ Q_..____ Foundatyon ___ ,�_____________ Property Line Q- -._.________ <br /> SEEPAGE PIT 'DOpth V - ----- DiameterJ-� Number ____ __________________ Rock Filled Yes�J° No f <br /> Water Table Depth ���-------------------------------R ck Size/--_'"' '---•---•--- <br /> Distafice to nearest: Well _A��l1---""_____________________Foundation Prop. Line ___________.___.______ <br /> REPAIR ADDITION Prev. Sanitation Permit# ____________________________________________ Date --------------.------..___..,__---) <br /> Septic Tank (Specify Requ�rementsy fi <br /> Disposal Field {Specify Requirergents) ____________ 4 <br /> -- <br /> y v <br /> _f__- <br /> ------------------------------------------------ -____________________�r_____-____________________________.____._______________________.______.______________._____.______ <br /> __________________ <br /> -i. <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 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 issueFd, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws !of California." <br /> Signed ------ - ------------ ------------------------------ caner <br /> I- <br /> By --- ----- -- -- <br /> ------------------------------------- <br /> t e �� t- <br /> "' <br /> - - <br /> f other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------------------------------` ------------------------ DATE -- -- -------------------- <br /> BUILDING PERMIT ISSUED ------------------------------------------------------------------'-------------- DATE ------------------- <br /> ADDITIONAL COMMENTS ----------- 1 _ - i:. -------- <br /> - --------------------------- ------------ ------=-------------- ------------------------------------------------------------------------------------------------------------------------ <br /> I, <br /> ---------------------------- - -- ------------------ ---------------------------------- _--_ ---__ ------__-----_--- ---- - ;r_ ------- ---- - --- <br /> - ------- - -- - - <br /> Final Inspection by- ------- '— Date <br /> iia r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M i.'`r <br />