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FOR OFFICE,USE: ., <br /> oi,�� .,-• APPLICATION FOR SANITATION PERMIT <br /> ---------------- = ----- =------ Permit No. ._ - <br /> t � Y. <br /> # (Complete in Triplicate) <br /> --------------------------------------------- <br /> N'/ Date <br /> ------------ --------N'/ 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 with County Ordinance-No. 5.49 and existing Rules and Regulations: <br /> JOB ---------CENSUS TRACT -------(._-___________ <br /> Q - <br /> Owner's Name --,,�lr_- ,�_�.t,�_ -T-- ---- <br /> Address -------/-:� --W. /c_ - Cit y 70701 C/ <br /> Contractor's Name _ ,X�?}, � � T ------------------------License J s-' _Q__ Phone `_!P4 <br /> Installation will serve: Residence grApartment House,❑ Commercial :❑Trailer Court ;❑ <br /> Motel ❑Other ----------------------------------------•-- <br /> Number of living units:--/------ Number of bedrooms�-_____Garbage Grinder �J��--__ Lot Size ___ -_t______________ <br /> Water Supply: Public System and name ---------------------- ----------- -------------- --- --------------------------- --------------------Private [}►_ <br /> ChardcteFof soil°to a'de th of 3 feet`` Sand' <br /> p [ 5ilt Clay'❑ Peat❑ Sandy Loam ❑ Clay Loarrr ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material-NO---If yes, type ----------------------------- <br /> (Plot <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 seepa pit permitted if public sewer is available within 200 feet,) N <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ Size_ X_7A Coo fx__ y___- Liquid Depth7-7-47 _'___________ W <br /> Capacity,4Q40---------7ypdW,)7Aj---- MaterialC_�*VE . No. Compartments -a----------------- <br /> Distance to nearest- C <br /> Well ----50-----------------------Foundation --------- ---__ Prop. Line _1Q-----:-------- <br /> LEACHING LINE [ No. of Lines �_ ----__.----__ Length of each line____'7��----.- -_--__ Total Length _/.-�,Q_'____:____ �k <br /> r Ar <br /> 'D' Box --.I--------/Type Filter MaterialdlaC&-_---_Depth Filter Material _1-!__------------------------------- <br /> Distance to nearest: Well _ o-_.____._:__ Foundation _fel---- Property Line_______________ <br /> L.. ,��..�..�.. .j <br /> SEEPAGE PIT [ ] Depth ----------------- -- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No .0 <br /> Water Table Depth -- ---- -- # ----Rock'Size-------------------------------- i <br /> Distance to pearest: Well ------------------------------ -- -------Foundation -------------------- Prop. Line ---------------------- p <br /> REPAIR/ADDITION(Prey. Sanitation Permit# --:----•---------------------------------?__ Date -------------------------_--------1 d <br /> Septic Tank (Specify Requirements)- _ _____________________ I <br /> Disposal Field (Specify Requirement"s,) A----------------- - -­-------------------------------------------------------------------------------------------•----------- <br /> ---- -- ---------------------------------------_ � ---------------------------------_ � ------ -- ---- - - <br /> -- "`i-- �- - - - -- _ <br /> _ _.------.� raw existin and re uired ad----- ---------------------- ------------------------- <br /> Jt /- (tiD ' g q addition on reverse side) <br /> Y' � <br /> }' I hereby certify that I have•prepared this application and that the Lrk will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, Rules and Regulation"s">S"f"the`San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following:- � <br /> "! certify that in;the performance of the_work-f6rwwhith'this-Werth it is',issued,I-shall-not-employ any person.in such manner <br /> ' as to become subject to Workman's Compensation laws of Californic." <br /> Signed - - -----f <br /> ------------------------------------------ <br /> -------- Owner <br /> BY � ------- ----- --------------------------- Title ` /.e__X __ <br /> (lf other than owns <br /> FOR-DEPARTMENT-USE-ONLY- .—. <br /> r APPLICATION ACCEPTED BY i J_l- ' --- ---- -- ---- - ------------- --------- DATE . g ; <br /> BUILDING PERMIT ISSUED ------------- <br /> ------------ =---------------= y DATE <br /> ADDITIONAL COMMENTS '_' - ---------- --`--- ---------------------------------------------------------------- ------------- ---- -------- <br /> ---------- ----- --- - ------------- ------------- _-------- ----- <br /> --------------------------------------- -------- ------------------------------ <br /> -- - - - --------------- -------------------- ---------------------- ------ <br /> _ r, ----------------- <br /> --: <br /> -------_----- <br /> -------------------�--------- <br /> -- <br /> - - - -- ----- ---------- <br /> y �b - - ----------Date ..... ------- <br /> Final Inspecti <br /> SAN,JOAQUIN.LOCAL..HEALTH,DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M - i <br />