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APPLICATION FOR SANITATION PERMIT <br /> ........................ ................ ........ <br /> Permit No. 7....-�1�.�.. <br /> (Complete in Tripllcate) <br /> .... ..... ...........................•--.............. Date issued �'/d'7G <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 <br /> In complianceywlt� County Ordinance No. 549 and existing Rules and Regulationss <br /> 308 ADDRiw TI N /V77Z5 .�SS/LOCA O CENSUS TRACT .......................... <br /> Owner's Name ............ f._... 7A�, ..tt //����}} ��... ...... J ' ......_Phone . s ',�1. ....._.. <br /> address ... .......................t`. .77.6.........�' `..` e rx'J.... ....... . ..... ......................................... <br /> Contractor's Name f a?�.,t..........................license #O? � -. Phone .. � ..— ._. <br /> installation will serves Residence M7Apartment House Commercial OTraller Court 0 <br /> Motel ❑Other-----------------------------------........ <br /> Number of living units-----4... Number of bedrooms ..-.....Garbage Grinder ............ Lot Size ----__l..__..�':'�........;.. <br /> Water Supply: Public System and name ..................................__--------...---------__....._..........._.._.... ......_---.......Prtvato <br /> Character of soil to a depth_aL3 feet,_Sand 0 -Silt❑ _.Cla Peat Q Sandy Loam Clay Loam [:70 T ,- <br /> Hardpan❑ o Material ............if yes,type ............... ............ V <br /> V <br /> iPlot plan, showing size of lot, location of system to relation to wells, buildings, etc. must be placed on reverse side. <br /> NEW INSTALLATIONt (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> . PACKAGE TREATMENT SEPTIC TANK R Sze...... 9............T...`.......... Liquid Depth .............. <br /> y <br /> Capacity .. Type _.. . Material..�as:4... Na. Compartments .....y......... <br /> r ___Foundation r r . Prop. Line—Ts................. <br /> Distance to nearest: Well .,.....-. ............. -----..._�.�...-•_-_-.. <br /> _EACHING LINE j No. of Line: .,�- .............. Length of each line.........4 �....... Total Length ..f ............ <br /> D' Box Type Filter Material Depth Filter Materiat f 4: ....................... <br /> Distance to.nearests Well .�,�..�:f""..`Foundation /.. ....:.. ...-. Property line ' " <br /> .... <br /> SEEPAGE PIT Depth .... ....... Diameter .-_..... Number ........ 0 <br /> ...� � .. ......._ Rock Filled Yes � No <br /> Nater Table Depth ..............................`................Rock Size �/�.1�.l..Ph /".. <br /> � r <br /> Distance to nearest: Well ..........1 ....................Foundation .....1 ..: Prop. Line <br /> -- - - <br /> REPAIR/ADDITION(Prov. Sanitation Permit ql'•` ............................................ Date ..................................I <br /> Septic Tank (Specify Requirements) ............................. ... ..... ._.......................................................... .... <br /> Disoosal Field (Specify Requirements) .................................-. <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 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 become subject to Workman's Compensation laws of California." <br /> gnee ..... ....... .. ......... .... ...... .. .. Owner <br /> By ..... .. ��, _`• --•- � ...... .................................... yitle ..... � <br /> (If o than owner) <br /> FO ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... ... .... ... .:................................................................ DATE . ./n.. .............:........... <br /> BUILDING PERMIT ISSUED DATE.........................__-----.. <br /> ADDITIONAL COMMENTS ..........1............ . ...............---..._.. ........... .................................. <br /> .... <br /> ........................ ...... • ..... .. .. .............. ------------•......................................... .......... <br /> ..... <br /> Final Inspection b ............Date .. ...... .................................. <br /> F,H 13 24 1-66 Rev- 5M S OAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />