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FOR OFFICE USE: <br /> APPLICATION" FOR=SANITATION PERMIT <br /> -------- -------`'--- ------------------ Permit No.. <br /> (Complete in Triplicate) <br /> ----------I------- � ------- ------- <br /> ( 'Date Issued <br /> ------------------------- ------------------------------- This Permit Expires I'Year From Dote Issued r <br /> Application is hereby made to the San Joaquin Local Health Districtlfor a.°-permit to construct and install the work herein . <br /> described.lThis application is made in compliance with County Ordinance No. 549-and existing Rules and Regulations: <br /> JOB ADDRESSAOCATIO ---- -------- ---------------------CENSUS TRACT ----------1.�----.- <br /> Sj ' <br /> . <br /> --------- <br /> t <br /> Owner ------------JACK ---------•-------------------------------------------Phone----------- -----. ..-------------- <br /> Address.-e----------------- --------wg- -tJ--- --- -------. City ------ - ----------------------------- - ----------------•--- <br /> iCEk di <br /> ontractor's Name - -- ----W/VS9��------------------------ I------------------=-------.License # ------------------------- Phone <br /> Installation will serve: Reside ncekApartment House❑ Commercial:❑Trailer Court i❑ ! i <br /> m <br /> 1 <br /> -_ <br /> Motel Other � -:-' <br /> s: mber oberaooms Garbage Grine9Lot Size .__ <br /> Y <br /> � ___------ <br /> Number of living unit / <br /> 11 F <br /> PP y: _+ Y { --- •------------------ Private <br /> Water Su I Public System and name <br /> Character of soil to a depth bf 3 feet. Sand'❑ Silt❑ Clay ❑ Peat Sandy Loam ❑ Clay Loam <br /> Hardpan Adobe°❑; _F.ill Material`___. _ _'Ifyes, types - <br /> )�.. <br /> (Plot plan showing size oaf lot, location of system, in relation to wells, buildings, etc. must be placed on reverse side.) �j <br /> ir public sewer is available within 200 feet,} ! <br /> EP TANK',' Size---____--- ,`_ ' <br /> NEW INSTALLATION: (No septic tank or'seepage pit permitted if'' x1� � � Liquid Depth -�__________________ 6� <br /> PACKAGE.TREA;TMENT-�-{,7�--=S I_C � ----- `-- ------------- - q P <br /> R �__ .�,r <br /> ;1 � K�No- Compartments'Capacity -/ 1rOC'�- •- WePe ---- ------ -.--��--- -----_Foundati- - -- - � P --••--�4----,....--- �� <br /> �ECFE�Material_('�l�`C <br /> -'�`. <br /> Distance to neo st: .___ _ on ___f� +____ Prop. Line ___�____ _________ <br /> _ . . . .._.w .._-... _ .. , 1 r <br /> LEACHING LINEj, No. of Lin s ____:____ Length of each line____ _______.;_____-Total Length sv......... <br /> D' Box __� _ Type Filter,MaterialT'�-- __--_Depth Filter Material --1- <br /> ------------------ - <br /> � � t ' --� <br /> Distance to nearest: Weld .......'Foundation ___1� ` Property Line. .............. <br /> SEEPAGE PIT "j i Depth --_____ Diameter _X. :_ Number ------------------- ________ Rack F'lled Yes ��o �❑ <br /> Water Table Depth ---- `---------- Rock Size �s =� <br /> L <br /> .. Distance.to-nearest:.WelL.___� ______r__ f`______________Foundat' n__.,� -_____ Prop. Line -------+_.___._ <br /> REPAIR/ADDITION(Prev. Sanitation Permit - <br /> Date <br /> -------------{-------------- <br /> Septic <br /> ___________._Se tic Tank (Specify Requirements) ------------------- P--/------------ ---f----- --- ------------ - <br /> fy Requirements) ..._-_---Disposal Field (Spec ` <br /> I - -------- <br /> 1 <br /> • <br /> f --! f rC`;��t <br /> ' �� _�.--{ ---- ----------- ------------------ <br /> -------•-- <br /> "g_ - {Drawekistin an required addition on reverse side) - - <br /> I hereby certify tV.hat hrhave,propared this application and that the work will be done en accordance with San Joaquin <br />' County Ordinances, SVgte Lci-rJS, WR es and Regulations of the.San Joaquin LocallHealth District. Home owner or licen- <br /> a �} <br /> sed agents sign'atdre ce ies the folio '.ag <br /> "I certify t in the p� ormanc rk for which this=pe" rmit is issued, I shall not employ any person in such manner <br /> as to beco -subject Work n° pensation I wa s of California." <br /> _____x.., `., . <br /> Signed - - ��, ` mow{-------------------------- Owner <br /> By ----- ------------ '"� Title ---------- - <br /> (If other-than owner) <br /> i <br /> FOR DEPARTMENT i USE ONLY <br /> APPLICATION ACCEPTED BY ----- � --- -------------- --------------------- -----------------------------------. DATE -----,---_�;----- <br /> BUILDING. PERMIT ISSUED --------- ----------------------- -------------------------------------=----- -------DATE ------ ------------- <br /> ADDITIONAL COMMENTS ----Z------------- -------- ---------- --------------------t- = ------ <br /> - :-- ------ _ =_ ----� --i = ------------------------------------------ --------------------- <br /> ---------- - --------- --•-- - <br /> ---------------------------------------------•----------------------------------------------------..,---------=---------------------- ----------------------------------- <br /> ---------------------------- -------------------------------------/ [------- l . . . . ---- - ._ . ------- �� --------- -----------------------------------------------•----- <br /> Final Inspection by _ -------------------------------- ----- <br /> •_... ,.�. _. ._.__..._ _-� ..... Date - ------- -- ------ - ----- --- <br /> t SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />