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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,,// <br /> Permit No. -7 --`.----7-- <br /> ---- --------------- ----------- -- {Complete in Triplicate) r/ <br /> ----- ------ ----------------------------------- Date issued -A"...-.-ryT-. <br /> -------------------- <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 �'� <br /> mad in com li ce th County Ordinance No. 549 and e }in Rules and Reg"ylations: <br /> �' - e f <br /> � .__/& l0v�KCENSUS TRACT ----------- -------------- <br /> JOB ADDRESS/LOCATION <br /> Owner's Name ----- <br /> Phone <br /> Address / i� A;/C�__- r -----�alV_f ----------. City .+ 't` t 1r '------------------------- - ---- <br /> ------- - - -- <br /> 'fes <br /> Contractor's Name ---/ A�-_"_�Cp0/P------------------------------ ---------- <br /> t <br /> --------License # ���'e���� Phone�1����-.. <br /> Installation will serve: Residence$Apartment House,FJ Commercial :[]]Trailer Cernt <br /> Motel ❑ Other ------------- -------------------------- <br /> 44 <br /> Number of living units:--./-___ Nu mber of bedrooms --,?e------Garbage Grinder _1YP--- Lot Size <br /> Water Supply. Public System and name ------------------------------------ ------------------------------- Private <br /> 4 Character of soil to a depth of 3 feet: Sand M Silt❑ Clay ❑ Peat❑ Sandy Loam' Clay Loam ❑ <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 /> i <br /> PACKAG TREATMENT { ] SEPTIC TANK Size' Liquid Depth , --------------- <br /> Capacity Type TypeFMaterial-_ .fr1��--`--- No. Compa'rtments --n�------•-•---.-� <br /> i �� <br /> Distance to nearest: Well -l al- ------ �_ i-' outid'ationt-1 --------------- Prop. Line -.--_-_�---__----..-- <br /> LEACHING LINE �Q No. of Lines _ 1� ___-_--- Length of eacline.__ P-------------- -- TotalLength ----- 1� <br /> k -------------- <br /> p' Box _ Typ�»Filter Material f �(�d Depth Filter Mater�af f ------------- <br /> : .,w .,� i_ , ted. • �._ --- <br /> R D stars a to nearesfi: Well '-.tfl _------ Foundation .-1 +---- Property Lines --------------- <br /> I SEEPAGE PIT [ ] Depth - ------------ - -- Diameter ----------__-- Number <br /> - Rock Filled Yes ❑ No (3 (' <br /> 1 ----- <br /> ' Water Table Depth - ---- 1` Rock Size <br /> l Distance)to nearest: Wel! ------------------` ---' '•-------•Foundation -------------------- Prop. Line ----------- -------- <br /> 1 11 <br /> REPAIR/ADDITION(Prev. Sanitati+n Permit# -------- --------------------I--------- - --- gate ) <br /> Septic Tank (Specify Requirements) -------------------- 1 - <br /> I -- ------------------------ - p <br /> ! Disposal Field (Specify Requirements) ------------- - -- <br /> E ----------------------------- ------- <br /> ' -----•--------- ------ <br /> 4-- %l <br /> ---------------------------------------- <br /> --------------------------------------------------;--s--------------='-------------------------------------------------------------------------- <br /> (Draw existing and required additiorf on reverse side) <br /> I hereby certify that I have prepared this application and thr�it'the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regula ns of the San'Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: " <br /> "I certify that.in the aerformance 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 `California." <br /> Signed ---- ---- - ---- --- - ------------------------------ Owner <br /> ------------------------------------------ Title - ------------ --- <br /> ------ <br /> fother than owner) <br /> FOR DEPARTMENT USE ONLY " <br /> APPLICATION ACCEPTED BY ---. - - - _ DATE --- - '-- -� ------- ------ <br /> BUILDING PERMIT ISSUED '#------ DATE <br /> ADDITIONAL COMMENTS ------- i--------------------------------------------------------- -------------- <br /> --------------------------------------------------------------------------------------------------------- <br /> ------------------------ ---- ---- ---------------------------------------------------------------------7-------------------------------------------- <br /> ---------------------------- - ------- - <br /> - - ----- <br /> Final Inspection b <br /> --------------------- <br /> - <br /> _ f ------------------------------Date "- ------ --------------------- <br /> ----- <br /> ----------------------- --- ------------------------------------------------ - <br /> SAN JOAQU.IN. LOCAL HEALTH DISTRICT <br /> v}� F_ H_.9 1-'6B Rev. 5M �_ <br />