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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------------------------- Permit No. -7 <br /> (Complete in Triplicate) , <br /> -------------------------------------------------------- <br /> Date Issued �77 ?i <br /> - - ---------------------_---_-------_----_-----_----- This Permit Expires 1 Year 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 and existing Rules and Regulations: <br /> JOB ADDRESS/LOtATI .--511 <br /> --7-T---W-------- ---------------------------------------CENSUS TRACT _ SrS`D--------- <br /> Owner's Name •---------------- - ---- <br /> ---------------------- ------.Phone------------------....-------------- <br /> Address -----------�--- ----- - ------------•---------------------------------------------•--- City '--=------------------------------------------ <br /> Contractor's Name �' ` ��@ �` <br /> 6�Ix1�-----�#'-�i�•----_,H nr'�--�--�-�'--------------------------License # ---------:-----�-- Phone --�-- ��-�-�----- <br /> Installation will serve: Residence D'Apartment House❑ Commercial:❑Trailer Court ;❑ <br /> t <br /> Motel ❑Other -------------------------------------- ---- <br /> . - r <br /> Number of living units:---I------ Number of bedrooms ---�-----Garbage Grinder __-I------ Lot Size --- OO_RE9---_- <br /> Water Supply: Public System and name ---------------------------------•---------------------------------------------- ------------------------------Private [ F <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ ,Sandy..Loa,n--Ej Clay Loam 0 <br /> 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-15-X,5_x-la---------------------- Liquid Depth --15--------------------- <br /> Capacity <br /> 1-------------------Capacity -J.,&-&OO- Type -------------------- Material AS*Fxjf- No. Compartments ---;;k-------:-.-. <br /> Distance to nearest: Well ----1-CLk------------------------Foundation ---------------------- Prop. Line -------------_-------. <br /> LEACHING LINE [ ] No. of Lines .------�------------ Length of each line-----t00f-----.-- g <br /> ---- Total Length --aOM- _____________ <br /> 'D' Box ---- Type Filter Material --------------------Depth Filter Material --------------------.----------------------- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line. ------------------------ <br /> R <br /> SEEPAGE PIT ( ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No I❑ <br /> WaterTable Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation --------------- ---- Prop. Line ---.------------.----- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --_-----.-----_---------__----_--) <br /> Septic Tank (Specify Requirements) ---------------------------------------------------•-------- .--------------------------- <br /> Disposal Field (Specify Requirements) -- -b e ' ----- ..... P i` --------------------------------------- <br /> gg <br /> -------------------------------------------------------------- ----------------------------------------------------------------------------------- ------- -------------------------------- I <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 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 issued, I shall not employ any person in such manner r <br /> as to beco subject to Workrylan's Compensation laws of California." <br /> Signed ------------------- f/��----------------- - Owner <br /> BY -------------------------------------- --------------------------------------------------------- Title --- ------------ <br /> ------------------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- -- _-k ----------------------- DATE ..--3_� - "-7.-- _ -- <br /> BUILDING PERMIT ISSUED --- -------------------------------------------------------------------------=--------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ----------------------------- ----------------------------------------------- ----------------------------------------------------- --------•- ---------------- <br /> ---------------------- <br /> ------ ----------------------- ------------- -------• ----------------------------------------------- --------------------------------------------------------------------- - ------ <br /> -----------------z------- <br /> - ----------------------- <br /> Date -------------------- <br /> -------------- <br /> ______________ _ __------------- ---- - --------------------------------- <br /> Final Inspection by SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> k <br /> E. H. 9 1-'68 Rev. 5M <br />