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FOR OFFICE USE: - <br /> APPLICATION FOR SANITATION PERMIt' <br /> ------- ---------------------------------------------- 69- b <br /> --- (Complete in Triplicate) <br /> Permit No_ ___________ _ _----- <br /> ---------- ---------------------------------------- ... <br /> This Permit Expires ]-Year Froin Date Issued Date Issued -��.:���7 <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 complionce-with County Ordinance No..549-and-existing Rules and Regulations: <br /> - i <br /> , '. JOB ADDRESS/LOCATION ._ f/d--co-},_ -- -- ff- --(2-r_�-- -------------------- - - <br /> CENSUS TRACT -------------- <br /> Owner's Name --- 0 a -------- -------Phone------------------------------------ <br /> Address ----- ---- ---- .3-1f------ - ----- ------ - City -- - ----------------------------------------------------- <br /> Contractor's Name ------------- --_--------,_--_---'License #�� -----___-- Phone ------------------------------ <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other ---------------------- <br /> Number of living units:------ --- Number of bedrooms __-.3-----Garbage Grinder ----------.- Lot Size _-_____.__:________ - <br /> Water Supply: Public System and name ---------------------------------­--------- -=----------------------------------- -------------------------Private [ <br /> Character of soil to a depth of-3 feet: Sand'Q -Silt❑ /rol <br /> ❑ Peat E-] Sandy Loom .0 Clay Loam ❑ <br /> HardpanF:1, Adobe Material ------------ If yes, type --------- <br /> (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: fNo septic tank or seepage pit permitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] '' Size---------------------------- ----- ----- -- Liquid Depth -----------.--------------------- -- <br /> Capacity ------------------ Type -------------------- Material--------- --- -------- No. Compartments ---------------------- <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- <br /> LEACHING <br /> -------------------LEACHING LINE [ ] No.. of Lines _.------------- __^Length of each line---------------------------- Total Length -__--__-___-___-___-___----_ O ' <br /> 'D' Box .------- Type Filter Material ____--_--__--__-___Depth Filter Material ____________________________________________ <br /> Distance to nearest:`Well ------- ----- ------- Foundation ______________________ Property Line. _-___-________-___._-__- , <br /> SEEPAGE PIT [ ] Depth ------ -------------I Diameter _-------_ - Number ---------------------------- Rock Filled Yes ❑.. No 0 <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well -------€--------------------------------Foundation -------------------- Prop. Line ------------------.--- <br /> i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------`------------------------ --- Date----------------------------------- <br /> Septic <br /> ----------------_Se tic Tank (Specify Requirements) i, <br /> Disposal Field (Spe ify Requirgnents) ----------------- <br /> ---------- = ---- --- -- -- -- <br /> 3 'f <br /> .9-®---- -" -- (Draw exist ng.and required ad � �� '-------- --------------------------- <br /> -j i. <br /> 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.DistricF 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 rr'ot.employ any person in such manner ' <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------ ----- Owner - ^' <br /> -- -------- <br /> BY - Title ---- -------------------- - ------------------------------- <br /> - <br /> ,. <br /> -: (If other than owner] �. <br /> FOR-DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- DATE - � <br /> BUILDING PERMIT ISSUED ------------------------------------------------ - <br /> DATE -- <br /> -----------------L-------------- <br /> ADDITIONAL COMMENTS ----------------------------------------------------------- ti ? . i <br /> ________________________________________ ___________________________________________________________________________________ __________ _ _______________________------____-- <br /> - ___ <br /> ________________________„-____._---------------------------------------------- _„_-_._-_ ------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------ -- <br /> _______.---------------------------_--- ------ <br /> _ - ----- ' <br /> - <br /> Final Inspection by; ------- ----- Date ` <br /> SAN JOAQUIN ,LOCAL HEALTH DISTRICT ` <br /> E. H. 9 1-'68 Rev. 5M <br />