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�= r <br /> • fOR OFFICE USE: AILICATION FOR SANITATION PERMIT <br /> ---------------------------------------------------- Permit No. -7j4 -....- <br /> (Complete in Triplicate) J <br /> - --------------- This Permit Expires 1 Year From Date issued Date Issued S_:��zJ__-.. <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 _ '[` - :--- - ------ ---- f`" Jg-a--------------------CENSUS TRACT -------------- ---- <br /> j Owner's Name --------------- --Phone.J 6 ---- .3f . <br /> Cit f --------------•------------- <br /> 9 <br /> Address Y <br /> _ n <br /> Contractor's Name - --- r�:=-------.License # �6, _x�_ Phone - _ I <br /> Installation will serve: 'Resi ' ce partment House❑ Commercial ❑Trailer Court ,❑ <br /> Motel ❑ Other --------------------------;------------------- 6� <br /> Number of living units: ----------- Number of bedrooms -�-_...Garbage Grinder ..-�---- Lot Size 5q_ -------------------- <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 ❑ Adobe ❑ Fill Material ------------ if yes,type ---_.-__-_---------------- U} <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) IT� <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) D <br /> PACKAGE TREATMENT SEPTIC TANK' Size--_--.-___-_---------------- - <br /> [ 7 [ ] - -------- Liquid Depth - - - ----------------- - <br /> Capacity _.------------------ Type -------------------- Material---------------------- No. Compartments -----------=-- ....... <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------:----:------ <br /> LEACHING LINE [ ] No. of Lines ----- ------------------- Length of each line---------------------------- Total ,Length C-`------.---.-------_---- <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -_-------___-_--__.--------------.-------- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line --__---_------_-._......` <br /> SEEPAGE PIT [ ] Depth --------- ------ Diameter ---------------- Number ---------------- ----------- Rock Filled Yes ❑ No 0 <br /> Water Table Depth ------------------------------------------I------Rock Size ---- --------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------- ........ , <br /> REPAIR/ADDITION(Prev. Sanitation Permit#.-._--_-.---------------- - ---- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) - d-0 -' - -- <br /> Dis osal Field (Specify Requirements) - ��,_ � 0y�_ <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. 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 subject to Workman's Compensation laws of California." <br /> Signed - - --------------------------------------------------------------------------- Owner <br /> BY1 - - ---------- TitleC /�_� <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY x <br /> APPLICATION ACCEPTED BY .6- -------------------------------------------------------------- DATE ?/---_----------------- ' <br /> BUILDING PERMIT ISSUED --------------=---------------------- ----------1-------------DATE -------------------------- <br /> ADDITIONALCOMMENTS ------------------------------------------------------------------•----------------------------------------------------------------=-------- ----------------- <br /> ------------------------------------------------------- -- ----------- - - ---------------- - ------------------- - -------------- - -- --------------- <br />• --------------------------------- - <br /> - - --------- - ------- ------- <br /> Final Inspection by: <' - -------=�--- ----------- ----------------------------- ---------------_-_--- ------Date _.` -1 ------------------------- <br />` SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i E. H. 9 1-'68 Rev. 5M 49 <br />