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FOR OFFICE USE: <br /> APPLICATION FQR.,5ANITATION PERMIT <br /> ------- --- ------ Permit No. <br /> (Complete in Triplicate) <br /> --------------------- ------ <br /> TO <br /> ---------_ r _ _ This Permit Expires ] Year From bate Issued Date Issued __�_��_" <br /> ----- ------ - -------------------------------- I <br /> Applicationiislhereby,made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described.3hi•5 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ._.__ _S: _5 ------- p -I_`P__e -�--------------------- CENSUS TRACT ------------ 7------- <br /> L! -----�-------------------PhPhone ------------------------------------Owner's Name dR � ' -- <br /> Address 2 ------= -_..-- - CitY ------------------------------------------ <br /> Contractor's <br /> ----------------------------•---------Contractor's <br /> Name ------------------ �........... -------------•---------License#'`--- - -=-------- Phone ---------------- <br /> Installation will serve: Residence ,': Apartment House,-❑'C mmercial ❑Trailer Cour. ',❑ <br /> Motel Other __-___.._ - <br /> -------- -------------- <br /> be '- <br /> Number of living units..---/--..- Number of rooms - Garba ge Grinc14 10-- Lot Size ----AC�_}96�---------.- <br /> i ! i <br /> Water Supply: Public System and name ------------ ------------------------------- ------------------Private <br /> Character of'soil to a de th of 3 feet:- Sand'Q Silt C1a Peat�A_Sand. Lodm. . —CI'a" Loam - <br /> P ❑ ❑ Y ❑r• Y Y. <br /> Hardpan Adobe.F� Fill Material If yes, type ---------------------------- <br /> (Pl'ot plan, showing size of lot, location of' system'lin 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 TANI(f ] Size----------------------------------------------- Liquid Depth -------.----------------- <br /> ' <br /> Capacity ----------- ---z TYPe ------------- Material---------------------- N Compartments ---------- •-•-=--- <br /> c-3r'� � _,� � - <br /> Distance to nearest. Well __ __ _____________________________Foundationk +_tom- _-_�_i'1___ Prop. Line ___________:__...--_ <br /> LEACHING LINE [ ] No. of Lines ______._____-- `"}�`Length of each line--------------------- - ---- Total Length ,_--_______._--_________.-- <br /> 'D' Box ------------ Type Filter aterial -------------i-----.Depth Filter Ma rial --------2-----------_----------------------- <br /> i <br /> Distance to nearest: Well _ _________�__.._--Foundation 4________.______--_ -- Property Line, ________-___--_-__._.._. <br /> SEEPAGE PIT Depth -- _-----Rock_Filled Yes No <br /> [ 1 P Diam f r Number <br /> Water Table Depth �--- ---------- ----- Rock Size f <br /> Distance to nearest: Well ___ _ _________\.---.-___________._Foundation! _ _ _.___.____-_ Prop. Line ...... ­------------ <br /> Distance <br /> (Prev. Sanitation Permit#�1____'-- -- ------------ <br /> Septic <br /> ----------- -----. --------------} <br /> Se tic Tank(S'(Specify Requirements) ----.___.1____.__.__-_-- ------------------ -- -- - ---- <br /> P P Y q - r ------------- - --------- <br /> Dis osal Field [Specify Requirements) r---- ?1ST------13a?�---- -- � __21------- ----E �1 <br /> ' Pp -----.-- ----1 -----5�_EPJ}. _- -_PjT 4` � �fr� -------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that sthe 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 /> l.._ <br /> sed agents signature certifies the following: _� r <br /> "I certifyITt in the performa e, o he work for which this permit is issuedr I shall not employ 6y-persoh in,-Wuch manner <br /> 9 <br /> - ------ - -- ---'---�=-- -----=Californias, I <br /> Signed __ + ` -- -- 1 ____ Owner <br /> as to bec subject to Work a o e ation laws of <br /> BY --------------------------------- - ---- --------- --------- <br /> Title . <br /> (if other than owner} <br /> FOR DEPARTMENT USE ONLY p <br /> APPLICATION ACCEPTED BY � �------=------------`----- ---------------------- ----------------- . DATE rZ/ ---------- <br /> BUILDING PERMIT ISSUED ---------------------------------------- =-------------!------------- ----------------------- <br /> --------------DATE -------------------------- --------- <br /> ADDITIONAL-COMMENTS - -_. -=-----=------------ = = ' - <br /> , <br /> _ ---------- <br /> --------- - �-----Y ------------------- <br /> f w F 5t <br /> ---- - - ----- -- �, - - . cite -- -- <br /> Final Ins ctio � � --------- <br /> ----- Date . = / -' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT " <br /> E. H. 9 1-'68 Rev. 5M <br />