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'7-OR OFFICE USE: A -� -4 <br /> APPLICATION FOR, SANITATION PERMIT07 <br /> Permit No. <br /> (Complete in Triplicate) <br /> - 7V <br /> Date Issued __-/�_---- <br /> This Permit Expire 1,Year From bate Issued <br /> Application is hereby made,to the San Joaquin Local Healt.� District for a permit to construct and 'install the work herein <br /> described. This application s m ide in compliance with County Ordinance, No. 549 ani('existing Rules and Regulations: <br /> 7 ----CENSUS TRAC <br /> r �._ t <br /> ,JOB ADDRESS/LOC -------- - / <br /> Owner's Name ------Phone ------------------------------------ <br /> ---------------- -- ------ -- ------------ <br /> ------------ -- ------------ <br /> (f �A0 <br /> Address ---- ----------- ---�----� ----------•- ----------------i^��>4�---�-�------------ City ---- -----:-----G-- ----------------------- --------------------. ---•--- <br /> License # - Phone ---=------- w <br /> Contractor's Name --------------------- ------------ -- <br /> Installation will serve: Residence ❑Apartment House Commercial Trailer Court 0 i <br /> Motel ❑ Other ------- <br /> ,Z <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:[] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ I <br /> Hardpan ❑ Adobe-❑ Fill Material ------------ If yes,type _________--_ _______--- <br /> (Plot plan, showing size of lot,location of s stem in relation to wells, buildings, etc. must be placed on reverse side.) 9 <br /> NEW INSTALLATION: {No sept?c�F'ar k_ seepage pit permitted if public sewer is available within 20( feet,) 1 <br /> PACKAGE TREATMENT [ ] SEPVC TA6K'{ ] Size-------------------------------------�--- quid Depth --- fffi <br /> �, --------- <br /> ' ____ No. Com artments <br /> LGa-ac' Type -------------------- Material--------` P --------------_------ <br /> Disfance to nearest: ��FavP4Dtion---__._.�--.--P-r_oP ine--.I---•- <br /> „_ k <br /> LEACHING LINE [ ] No. of Lines ------------------------Le ach line---------------------------- Total Length ---------- ------------ <br /> No. a <br /> Box ------------ Type Filter-M erial ------- ---------Depth Filter Material --------------------------€---------•-•----- <br /> C)i�tnrxe-to-neafs# ell ovrtda-tt - rope�ty Line. --------••----- i <br /> SEEPAGE PIT [ ] Depth _ "__._______--""- Diameter ____ Number ----------------------- ---- Rock Filled Yes 0 No iC <br /> Water Table Depth ---------- � i---------------------------Rock Size ------ r----------------- � r <br /> Distance to nearest: Well _ --------------------------------------Foundation -------------------- Prop. Line ____________------•-•- <br /> REPAIR/,ADDITION(Prev. Sanitation Permit# ------------------I---------------"--------- Date ----------------------------------1 <br /> Septic Tank (Specify Requirements) ----------- - ----------------- = ' <br /> --c-------- '� - <br /> a <br /> 14 1 <br /> D• sa Field; (Speci'Y equjremZnts) _____ - ------------------------- " <br /> [p� ` <br /> -- ----- ----------------------------------- -----------------------------------�- ' ! ------------- <br /> I (Draw existing and required addition on rev€rse side) �� <br /> that I ha�erpia bred.this application and that the worlr will be done in��fciord nce with Sin Joaquin <br /> 1 hereb. certify `� p k <br /> CountylOrdinrances, State Laws, n� Rules and Regulatioiof then Joaquin Local Health District. Home owner or licen- <br /> 3 sed agents signature certifies the following. <br /> "I certify that in the performance of the work _ich tFiis hermit is issued, I shall not elm+-an person in sumanner <br /> y f � �.. I <br /> i as to beta a subriect to Workman's Cornpensatjon lay_"i California. <br /> Signed <br /> _-- k�x Owner <br /> f . <br /> ay --- <br /> '- ------------------- --------- _ - <br /> By ------ = ,r{ =------------------------------- J---- - �'r �l��� <br /> _ T'tCe <br /> tj <br /> if other than owner <br /> �✓ OR�DEP RT MENT USE ONLY <br /> r U c ] � <br /> f '"`� `y._.�----�\= - DATE <br /> APPLICATIOf9�ACCEP7ED BY .___.--.r�_____----'----- � i � <br /> L BUILDING PERMIT ISSUED ----------------------------------- --- ---------------- <br /> ADDIT16NAA�`COMMENTS <br /> -------------yy------------- <br /> ADDITIONAA`COMMENTS --------------------------------------------------------------•-------------------- <br /> --------------------------------------------------------------------------------------------------------------------------- <br /> - ------ ----------------- ------------ ----------------------------------------------------------------------------------- <br /> -------------------------- <br /> }-------------- -- -, "r _.__ <br /> f � -r <br /> Final Int action.b --------- ------------------ .Date ----- - ----- <br /> -`. SAN JOAQUIN LOCAL HEA*H DISTRICT <br /> r" { ` a <br /> E. H. 9- 1,-'68.1Rev..5M Y <br />