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FOR OFFICE USI:: APPLICATION,FOR SANITATION PERMIT <br />,................. (Campleto In Triplicate} <br /> Permit No. . <br />....................................................... Date issued <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 construd and Install the work herein <br /> described. This application Is made In compliance with County Ordinance No. SA4 and existing Rules and Regulations <br /> JOB ApDRESS/L TION .. .i^. �. ..��`.-. ............ CENSUS TRACT .............:.............. <br /> Owner's Name 'r�!. r.. p'.............................. ................. ... ...................................Phone .......................:............ <br /> Address .. 7 ... ......-- •.....................................City -• .............................. <br /> ........ .. ..... <br /> Contractor's Name ..s �. .--•••._...................................License # �!9�d'�•�.. Phone <br /> Installation will serves silence[]Apartment House Commercial❑Traller Court ❑ <br /> Motel p Other..................••--•-----•--•-•-- ....... <br /> Number of living unitt:............ Number of bedrooms ......Garbage Grinder ------------ Lot Size ..................._.. ..................... <br /> Water Supply: Public System and name . .......:.... ..................... ....•- --.._.� ............................................ffrhrats❑ <br /> Character of soil too depth of 3 feet: Sand t3 Silt Q Clay ❑ Peat Q Sandy Loam ❑ day loam❑ <br /> r Hardpan❑ Adobo❑ 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 INSTALLATIONs (No septic tank or seepage pit permitted If public sewer.is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK I ] Size . ..........1...................... Liquid Depth .. <br /> .................�.. <br /> Capacity f��p....... Type _... . Material---------- ---------- No. Compartments I.,----.. . <br /> . <br /> Distance to nearest: Well ....................................Foundation...................... Prop. Line ........`.......... <br /> LEACHING LINE [ ] No. of Lines ...D................. Length of each line....-7e f..............Total..Len th <br /> 'D' Box .�..------ Type Filter Material .± ...Depth'\*Ilton MaterialJ-a.................................. <br /> Distance to nearesh We Zap. �...... Foundation ........................ Property Line ................... <br /> SEEPAGE PIT { ) Depth - ---•.... ...... Diameter -------------_ Number ........................... Rock Filled Yee [3 No ❑ <br /> Water Table Depth ................................... ............ Back Size ....._........:............. <br /> Distance to nearests Well .......................................Found ion -................... Prop. llne .................... <br /> _.. D to } <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ........................ • .. . .:..`-- <br /> i !r <br /> Septic Tank (Specify Requirementsl ......................................... ....................................................................._.--.... .. <br />:. i <br /> Disposal Field (Specify Requirements} -•............................................•--•.................._............. <br /> ............................................. .......... . .................-........................I......................................... <br />#' ---•....................... .................._......................... ........ <br /> ... ..... ............. <br /> .............................•-•-••-----....---p.......--- PP <br /> (Draw existing and required addition on reverse tide} <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with Sant Jaaeltsln <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or iicen• <br /> sed agents signature Certifies the followings <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 pNect to Workman's Compensatloylaws of California." <br /> . Signed • ...•°•� ............. Owner <br /> B ................ .... ..................... Title --... ...-•----...................................................... <br /> y <br /> (If other than owner) <br /> ' FOR DEP A NT LlSfb�ONLY <br /> APPLICATION ACCEPTED BY ...... -.• - .... ....................... DATE <br /> BUILDING PERMIT ISSUED ..... ...............:.. ..... <br /> .DATE ...:...................----.........:- <br /> ADDITIONALCOMMENTS •.............................•--•---•--.-.............-•----•--....................................---...............--.-•---.....I.....----..........-•--.... <br /> ........................... <br /> ......... <br /> :............. ...-----.............. .Dai'....... <br /> .. ..5.. " <br /> ...- <br /> Final Inspection by: a .... '•� � <br /> Ell 13 24 1-68 Rev. ,e,N JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />