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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. -7a <br /> (Complete in Triplicate) <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> 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 °Z_� _� - �__ ___ <br /> G -�_�- = CENSUS TRACT <br /> Owner's Names/ --- =-- = PhoneG _" _ _. <br /> �yy� --- <br /> Address �1c�-la.�-- -•-.;� - ---------e----- ------ City - - - - - -------------------------------------------- <br /> ---- <br /> --------=--- --------------------•-••----- <br /> Cont.ractor's Name ---�_--. -�-- �_--,�- --- : --- ----..License #V-4- -�^�~��Phone _ _��_ _�_�__�� <br /> Installation will serve: Residence ['Apartment House❑ Commercial ❑Traller Court ❑ <br /> Motel ❑Other _________ <br /> ----------------------------------- <br /> i <br /> Number of living units------------- Number of bedrooms _______Garbage Grinder ------------ Lot Size ____ ___ ------- ----"__.________ <br /> Water Supply: Public System and name ----------------------•--------------------------------------------------------------•--------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay ❑ Peat❑ Sandy Loam [ Clay Loam .C] <br /> Hardpan ❑ Adobe❑ FiII Material------------- If yes,type ----------_`~Y___________ <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 /> PACKAGE TREATMENT f ] SEPTIC TANK:[ ] <br /> Size________________________----------------- ______ Liquid Depth _._________---•._- <br /> - ------- <br /> --=41 <br /> Capacity --;s--------------- Type -------------------- Material---------------------- No. Compartments ------- <br /> Distance to nearest: Well ------------------------------------Foundation ----------------------- Prop. Line ....------ ------- <br /> LEACHING LINE; [ ] No, of Lines ________________________ Length of each line----------------------------------------- Total Length ;_____.___ <br /> 'D' Box .----------- Type Filter Material --------------------Depth Filter Material -------------------- _.__---.--- ---- <br /> Distance to nearest: Well ________________________ Foundation Property Line ____________-____---_ � <br /> SEEPAGE PIT [ ] Depth ._____ ------------ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ ) <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ________________________________________Foundation --------------- ---- Prop. Line ____.__ :----:'"---" <br /> REPAIR/ADDITION(Prev. Sanitation.Permit A ________ ____ __------------ Date --------- ---------- <br /> Septic <br /> _____Septic Tank (Specify Requirements) ---- ✓ ,• -�" -�`* ,,, . ":• r'" <br /> Dispos)Meld (Specify Requirements) --------------- ----------- ---------------; --------------------------------- - ---------------------------------------•------- .� <br /> -- ------- - --------------------------- ------------------------ <br /> �... <br /> ------------------------ <br /> Draw existin and re uired addition on reverse side) <br /> I hereby certify that i have prepared this application and that the work will be done in auordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home 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, I 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 - 4F" ,r±fox_. Title _------ �_ 4"y---- --------------------------------------- <br /> oche tan owner) , <br /> ,-FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - - ------- -------------------- --------------- DATE - ------ �------------- <br /> BUILDING PERMIT ISSUED ------ -----=- ------------------------ -----DATE ------------- ---------------- <br /> ADDITIONAL COMMENTS ----------------±----------- ----------------------------------­­ ------ <br /> k <br /> Final Inspection by ------------- ------------ ---- Date/a - ---f-- f-- ---------------- <br /> 1 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />