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f ' <br /> 1 <br /> FOR OFFICE USE: <br /> __ APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No.-7_�----------------- <br /> ----------- This Permit Expires 1 Year From Date Issued 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/LOCATION .-- ZZ�_- ---- ------ __-CENSUS TRACT ----------------_-------- <br /> - ----------------------- <br /> Owner's -------- -------Phone.. <br /> Owner's Name .----------- ---- --- - - - - --- '- ------------ --------�-------- <br /> ---------- -- <br /> Address ---------------------- " 7� ___>_ ------- -----•--. Cit -----------------------•---•---•-- <br /> Contractor's Name ----------------------Pei- -_--- � - <br /> - ----- --------------------------- License # /CW-��-�----- Phone ..-•--- <br /> fnstallotion will serve: Residence �Apartment Housef] Commercial ❑Trailer Court ;❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:----I------ Number of bedrooms'---3------Garbage Grinder ------------ Lot Size -----!7(�_X_J_Z ..-. <br /> Water Supply: Public System and name ---------------------- -------- ----------------------- - ------ - --- ••--••-.------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand [-] Silt❑ Clay ❑ Peat❑ andy Loam ❑ Clay Loam ❑ <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 /> Lf <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size--------------------------------------------------- Liquid Depth -_-------.----_-_--_- ---. <br /> Capacity - ------------------ Type ---------------:-- Material--•--------- --------- No. Compartments ---------------------- <br /> Distance to nearest: Well -----------------------------------.-Founclation ---------------------- Prop. Line --- ------------------ <br /> LEACHING LINE [ ] No. of Lines ------------- Length of each line;---------------------------- Total Length --__-_.-_-•_-.--.__--._.__ <br /> 'D' Box ------- --.- Type Filter Material --------------------Dept[i-Filter Material -._____-__--__---------------------------- <br /> Distance to nearest: Well -------------------7-'. Foundation -------------------------- Property Line -__-----.---------.-.--- <br /> w <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ----------------------------- Rock Filled Yes ❑ No <br /> Water Table 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) ----------- -•------ ®-- rl',( Ci`9--- -tr4x------�---------------------------- <br /> ----------------------------------------------------- ----- �.���'-----,,-c 2-4--------C- ----------------------------------- ---- ------------------- <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. Borne 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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed --- ---- --- -------- ------------------------------------------ Owner �. <br /> BY ( -------------------- Title ---- r------ --------- ------------------ ------------- <br /> ----- <br /> (If othe tan owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- --- ----- ----- ------------------ DATE -- � ` <br /> BUILDING PERMIT ISSUED -------------- -----------.--DATE ----- ------------------------------------- <br /> ADDITIONAL COMMENT -. --. -- �� <br /> = s7- ,� --------- -------- - -------- ----------:-------------------------------------------------------------------- ---- <br /> -- - ----------------- ------------------------------------------------ - -- ------ - -- -------------------------------------------------------------------------------------------- <br /> -------- ------------------------ - ----- to � r <br /> ----- - --- --- ---------------------------------------- --------- - ------- <br /> Final - ------- <br /> nal Inspection by: --- - --`�J ---- - - -- - --------------------------------------------------------Date --- - --- --U------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M '� <br />