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FOR OFFICE USE: v q 7 <br /> APPLICATION FOR SANITATION PERMIT �` <br /> ±' <br /> --------------•-------------------•--------------------- � L, Permit No. -�--Z`--�--`�-� <br /> (Complete in Triplicate) 1I <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> --------------------------------------------"- ---- _ <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 ----------- 3�a -------X4�t ` �d C ------ ------CENSUS TRACT .......... <br /> Name ______--___ _Phone __ _ --------------------------- <br /> Owner's .. <br /> -� /D / � �P,IUr41 ----------_- <br /> Address ----------- 3`J` � Z� ---- °`sem" �----------------- City ------------------ ; <br /> Contractor's Name -------- ------------------------------------ -------License # ------- -.----- -------- Phone ------------•---_-•-- <br /> Installation will serve: Residence [-] Apartment House-E] Commercial ❑Trailer Court 0 <br /> Motel ❑ Other -------0 olatL _ -_-- <br /> Number of living units:___,5--._ Number of bedrooms __,:,__.._Garbage Grinder -Yam- Lot Size ""__________________________________________ j <br /> Water Supply: Public System and name ----------------------•----•--------------------------"---------------•-----------------------------..._......Private;; 1 <br /> Character of soil to a depth of 3 feet' Sand'❑ Silt❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam .E] <br /> Hardpan ❑ Adobe Fill Material ____________ If yes, type ____________________________ <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 { ] SEPTIC TANK f J Size________ _ ___________ ------_ Liquid Depth -_-__._____-__________-_-- <br /> - ��______________ f <br /> Capacity /-ROO--__-- Type Material______________________ No. Compartments ____�__.!............ W <br /> 4S 1 <br /> Prop. Line .;SV <br /> Distance to nearest: Well _-_____ _Q�_________________Foundation - ____._..______ <br /> LEACHING LINE [ ] 'No. of Lines ______________ Length of each I'ne_.___ _� _-`-------- Total Length,__ ... <br /> Z L7 <br /> D' Box _ Type Filter Material �ep#�i Filter Material -------------------------------------------- <br /> fT t ' <br /> Distance to nearest: Well ____-�t9�______ Foundation ________________________ Property Line __-_c.S�.i._______.__ <br /> SEEPAGE PIT [ ] Depth -------.:------------ Diameter ________________ Number .--_`--------___--_-.---_ Rock Filled Yes ❑ No ❑ <br /> Water Table Depth --------------------------------------Rock Size ---------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation ---------------- --- Prop. Line _------.----._-_---- <br /> --REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _------.-----------.-------------_) <br /> SepticTank (Specify Requirements) ---------------------=-------------------------------------------------------------------------------------------I--------------- ----------- <br /> Disposal Field (Specify Requirements) ____________ <br /> ------------------------------------------------- --------------------------------------------------------------------------------------------------------------------=------------------------ <br /> ---------------------------------- <br /> ------------------------------------------------------- _- --------------------t-------1-----------------------------------------•--- ------- ------ <br /> (Draw existing and required addition on reverse side) f <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 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 b)ect to Workm m's C mpensation laws of California." <br /> Signed — ....................... <br /> ----- --"---_. Owner i <br /> BY Title l ------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED BY --------- ----=-------! ------ -------------------------------------------- DATE -Z' ---- ----- -T,------------ i <br /> BUILDING PERMIT ISSUED -------------- - ----DATE -------"---.---_-------------------------__ <br /> ADDITIONALCOMMENTS -------------- -------------------------------------------------------------------------------------------------- ----------------- --------------------------- <br /> --- ----------------2. 5M <br /> ---------------- - --------------------------------------------------------------------------------------------------- --------------------------------------- <br /> --------------------- <br /> __________ _ __ __ _____i__• - -_-"________-,._-_-______.-_______--______--___-------"_---------------- ___----------- _-"__.-_____ <br /> _______________________________ __ _ _ - __ ______________-_____-_____"__"_________-____-______.________-____-________________________________________________.________.__.-______ <br /> Final Inspection by: ----- --------- ---------------------- __Date " _f- ?---1 <br /> S JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 R <br />