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1 <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br />......................... <br /> (Complete in Triplicate) Permit No. <br /> ...--......... <br />---•................................:................ This Permit Expires 1 YDate Issued <br /> ear 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/County Ordinance No. 549 andexisting Rules and Regulations: <br /> JOB ADDRESS/LOC 710N TRACT .......................... <br /> Owner's Name .. --------.Phone ..af,� -l.. a ' r <br /> ..... . <br /> Address ..... <br /> ----------- -- ---------------• ---•----•-•. Cit ....- _.__ <br /> Contractor's Name .. .---- - .- - ----- --------------�--..... License #�---.... Phone . '�. .� <br /> Installation will serve: Residence Q Apartment House-E] Commercial ❑Trailer Court 0 i <br /> Motel ❑Other ...... .............................. <br /> Number of living units:....... Number of bedrooms .3------Garbage Grinder ............ Lot Size ................................ <br /> Water Supply: Public System and name ---------------------------.............. ....._ ..................................---...-------- .---_-.--.-Private ❑ <br /> -_ �-Peat j Sandy Loam [Clay Loam ❑ <br /> Character of soil to a•depfih of 3 feet:�a Sandd � Sift <br /> Ad�e ❑Clay <br /> Fiil❑Mater',al . ' <br /> k <br /> 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,) l <br /> PACKAGE TREATMENT ( ] SEPTIC TANK[ ] Size................................................ Liquid Depth .......................... <br /> Capacity . .'. ._. .... Type ................ Material-...----. ---- No. Compartments ---------------- <br /> Distance <br /> -----••........Distance to 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 /> J Distance to nearest: Well .--..--...- Foundation ................. Property Line ....................... <br /> � <br /> SEEPAGE PIT ( j Depth . ...._...- Diameter ................ Number ........................ Rock Filled Yes ❑ No I]' <br /> Water Table Depth -----------------...............................Rock Size -•------ ................ off. <br /> Distance to nearest: Well ........................................Foundation ............-------- Prop. Line .................. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------............•.-- .-.......... Dote ----------•.......................I tp <br /> Septic Tank (Specify Requirements) ....... . --------------- --------- - 1 <br /> Disposal F' Id (specify Requirements) ..-•-----•,,-/- --- --Gtr �cJ_ y <br /> Tom` d'.................. ... <br /> ........ GC:S' ../aJC--. .. - _ tee, <br /> �-i��E�u -----LGA-----G��Ol�.�,...�---.�/,K-..-�F-- -/��.�-----•---.... <br /> .... .... ....... -------­--------- <br /> (Dra'w existing and required addition an reverse side}T - <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 of 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 beco a subject to Wo an's Compe'osation laws of California." <br /> Signed Si <br /> 9 - - .. .- ��W..-.-....-- _. Owner <br /> By -... ........................................................... -----.-...._ Title - ..-... ........... ...........-- ..-.-..... <br /> llf other than owner) <br /> --.—_-- — __- - FOR DEP*RTIOENT USE ONLY yY <br /> APPLICATION ACCEPTED By .. _. ._._- ----- DATE .-. -.. ~' �'--- ----------• <br /> BUILDING PERMIT ISSUED ----.._--• ............... ------ ------------------ -- --- ---------.DATE . .. . .-------- <br /> ADDITiONAI COMMENTS :...... . ................-�`..--..........-...-.-.......--..-..-......-..-...-.... / <br /> _..-------- .---- ..r- -� -- •---• ..-.. -•-------- ............ .....--- ---••........................•. <br /> Ins -- •---...b ...-.....- - - - ---------- -------------•---•---• ..................... <br /> Final Inspection b �7 �- -------- ------- - -- -- -- --- - ------ ....... -- -Date .-.....------ . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. I 3' 24 1-'ea Rpv...511A -7/77 ,; <br />