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f <br /> i <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ---------------- ---------- - — Permit No. . Y` � <br /> _l -lCompiete in TripVcatse) <br /> ---------------- - <br /> - ------ - ---------------- -------------------- <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 construct and install the work herein <br /> described. This application is made in compliance <br /> 7with <br /> `yCounty Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION .------�7_--�-�----------- ail--E---f-�-��--hCENSUS TRACT -------------------------- € <br /> Owner's Name -14 / -----------------------------------------:- _------ ------------Phone <br /> Address ���� ------ ------I---------- --------------- ---- --------•--- CitY -} <br /> -------------------------------------------------- <br /> Owner's <br /> ---------- - ------------------------ <br /> � - -- �q <br /> Contractor's Name -------------- - -- /-------- -----.License # .%- _ Phone - <br /> Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court icl <br /> r <br /> Motel ❑Other -------------- --- ------------------------ i <br /> Number of laving units:---- Number of bedrooms ---�----_-Garbage Grinder 49- Lot Size - '�- --------------- <br /> Water Supply: Public System and'niame ------------ ---- ------------------ -------- ---------------------------------------' "--------------------Private Jf <br /> Character of soil to a depth of 3 feet: Sand'o Silt 0 Clay ❑ Peat❑ Sandy Loam Clay Loam C] <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type --------------_-.-----_-— <br /> (Piot 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--------------------------°--------------.- ---- Liquid Depth -------------------------- 1 <br /> Capacity --------- - -------- Type -------------------- Material-------------" No. Compartments ------I--------------- <br /> Di hnce <br /> •----------Dihnce to nearest: Well -----------------=------------------Foundation ---------------------- Prop. Line -------- ....... <br /> LEACHING LINE [ ] No'�of Lines ------------------------ Length of each line______ -------------..----- Total length ----- -------- ----------- <br /> 'D' BOM\------ Type Fitter Material --------------------Depth Filter''Material --'*---------------- --------..-----•: ---- 1 <br /> f . <br /> Foundation's .".-'-._ ----- Pro br Line <br /> Distance nearest: Well is ' p, tY <br /> I <br /> SEEPAGE PIT [ ] Depth -_ ...........77"-,Diameter ---------------- Number -----------------?----------- Rock Filled Yes ❑ No 1❑ <br /> kWater Table Depth ----------- ----------------'------- ----Rock Size ------ -- I--------------- <br /> Distance to nearest: Well ---------------------------.7-----------Founclatibn -----;r_.'------__A Prop.yLine _---------.--_---.-..- <br /> S <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------- ------------ --------------- Date ------------ ------ <br /> Septic Tank (Specify Requirements) � �'° ' � �1 ; '' <br /> Disposal Field {Specify Requirements] ------- --------------------------------------------------------------------------- ------------------------ <br /> ,,.�� <br /> E --------------------------------- " ..} f -' - <br /> ------------------------ <br /> -------------- --- ----- rf - i <br /> ----- ---- ------ ------------------- <br /> (Draw <br /> (Draw existing and required additionkbp i <br /> revers 4side) <br /> I hereby certify that 1 have prepared this application;and that the work will be done in accordance with San Joaquin i <br /> County Ordinances, State Laws, andRulesand Regulations of the San Joaquin Laval Health Dist-rict. Home owner or liven-�`" , <br /> :F <br /> i sed agents signature certifies the following: ' 1, <br /> "I certify that in the performance of tthe work for which this permit is i�s ued, I shall not employaany person in such manner <br /> as to become subject to Workman's Compensation ',laws of California.'d <br /> '1.. <br /> Signed Y ---- <br /> ------------ Owner ,# r <br /> -------- <br /> : � t <br /> r" Title I i�Grv'r�. <br /> ---- ------------- <br /> ' B ----- ------- <br /> Y - ;- <br /> (Ifo t a owner) <br /> I " FOR; DEPARTMENT USE ONLY r <br /> z ? Y <br /> APRLICATION ACCEPTED -- -- ------ -�--- - YY1-------- -------------- ------------- ------ ------------------ DATE ------� - `� `�' --------------- <br /> -- <br /> BUILDING PERMIT ISSUED -- ----------=- ----- ---------------------------------= '-----------------------------DATE <br /> ADDITIONALCOMMENTS ------ ------= -------f ----------1------------------------------- ---:--------------- ----------------- --------- --------------------------- <br /> t ------------------------------------------- '`--------------------------------------------------------- ----------------------- <br /> ------------ <br /> ►.:: <br /> ~-- <br /> 1 <br /> ------------------ <br /> --- ------------------- <br /> Final Inspection by. - Date - -? <br /> f <br /> SAN.,JOAQUIN LOCAL HEALTH .DISTRICT, <br /> E.-H. 9 1-'68 Rev. 5M <br />