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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ..._ Permit No. <br /> (Complete In Triplicate) ' <br /> .................................... This Permit Expires ] Year From Date Issued 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. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION <br /> ]j..._ ¢ - ..... 7sJ,GCrs.t.t?.......... C• T4' ..�...-.CENSUS TRACT .......................... <br /> Owner's Name .__..._.. l._. .........................I......I.................... <br /> ... .................,...Phone ...... <br /> %.4�. ._. _.__._1�I. Cd�=:li:._ tyc. ?a� .....L. �. "............. <br /> Address . . Ci <br /> Contractor's Name .._. _ t. '.� ... z:�,t �E. rr/�...............License # Phone <br /> Installation will serve: ResidenceVq Apartment'House❑ Commercial❑Trailer Court ❑ <br /> Motel ❑Other .....L............... <br /> Number of living units:... Number of bedrooms __..,..:Garbage Grinder .... ....... Lot Size . C . s ' .......... <br /> 7 <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 ❑ <br /> Hardpan d Adobex fill Material ............ If yes,type............... ............ <br /> (Plot pian, showing size of lot, location of system in relation to wails, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,] <br /> PACICAG£ TREATMENT ATMENT [ J SEPTIC TANK f ] Size........--....................................... Liquid Depth .......................... <br /> t: <br /> � <br /> ----_ Type .................... Material---------------------- No. 'Compartments ----------------- ._�t�re�cj Capacity •-- ---•------ YP p - -- <br /> Distance to nearest: Well -----------.........................Foundation .....I................ Prop. Line ..........`..........s <br /> LEACHING LINE [ ] No. of Lines -------/--------------- Length of each line....... •.---........ Total Length ..... '4�✓__..-..__ _..),1 <br /> x(5 �� _ D' Box .../_..... Type .Filter Material _3r� x.l .Depth .Filter Material .... _...__. <br /> Distance to nearest: Well _....'"�_�._____..._ Foundation ../`c�..�.......... Property Llne ... ./.s _�.`..._.. <br /> SEEPAGE PIT [ j Depth ____________________ Diameter ................ Number ........ ........ Rock filled Yes ❑ No <br /> Water Table Depth ................................................Rock Size ................................ A' <br /> a <br /> Distance to nearest: Well ........................................Foundation ..........ft........ Prop. Line ......................� <br /> REPAIR/ADDITION lPrev. Sanitation Permit# -------------------------------------------- Date .................................. <br /> SepticTank (Specify Requirements) ---•-------- -------•------------------------- -------------.-----------------•--..,......................_..............._----------------- <br /> Disp al Field (Specify Requirements)_ -_- - �r� .F„�._. --•- - - _-- X/.o X- -a. ----. <br /> J � �- �.---- --— ---------------- <br /> -------------------- <br /> - •-------- <br /> ------------------------------------------------------------------ -----------------------------------------..................................................... ...................................... <br /> (Draw existing and required addition on reverse side) <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. Horne 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 becoT jest to Workman's �ensai ion laws of California." <br /> Signed _.. __. :__-- _. __.--_-_-_ Owner <br /> BY -------- ---------------•--- -- --.. Title <br /> (If other t a owner] <br /> ,FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B ---------------------- ------------ DATE 3-- - '.Z. --------..._ <br /> BUILDING PERMIT ISSUED -------• •-------- ------------••----r............................---------------------------------------DATE <br /> ADDITIONAL COMMENTS <br /> --------------- <br /> ------•----------------------------------------•-------•.......----------........--•--------.... ----------- --------- <br /> ..: <br /> ..........•---------------- - <br /> P 1 • <br /> Final Inspection by: _.. �1 -- --•-----••---••--------------- ------•-•--- --•-----•-- ---------------•----------Date .... <br /> .'. --1__" ......_............. <br /> EH 13 2h 1-68 v• 5M SAN JOAQUIN LOCAs. HEALTH DISTRICT 8/74 3M <br />