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n <br /> t . f <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 <br /> Permit Na - 7 <br /> -------- --- --------------- <br /> Z <br /> -------------------- (Complete in Triplicate) P <br /> -----"- ------------------------------------------------ 7 <br /> Date Issued <br /> This Permit Expires 1 Year From Date Issued t _ <br /> ii <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 model' compl'ance with County Ordinance No. 549 and existin Riles anyifR�atil <br /> JOB ADDRESS/LOCATION ,.�'v'� TRACT r 't -,------- <br /> Owner's Name --------------- - �f� uu i�l <br /> Phone --------------------• --- -------- <br /> Address -- ------------ - ---- ------------ - ---"- ' - CitG - ----- - - k..----- <br /> -Contractor's Name ------------------- -- __-------------------------------------------- -------.License #Z3py-------- Phone - <br /> ~ <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court 'El <br /> Motel ❑ Other <br /> Number of living units;-----1----- Number of bedrooms ---5--...Garbage Grinder .�6.----- Lot Size ____ ..---------------------- <br /> Water <br /> _-----_-_ -Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ,E] Clay Loam ❑ <br /> rHardpan ❑ Adobe.& Fill Material ------------ If yes,type ---------------------------- <br /> ,a <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 orseepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size-----------_ __ ._.'! f <br /> Va- --- - Li Liquid De th 7A'-- <br /> .� <br /> Capacity - -- _ __ Type .� - _____ Material_L4J 4t �___ No. Compartments •------- � <br /> if / F � I <br /> Distance?to nearest: Well ---_16-------__- Prop. Line _--_ <br /> INo. of Line ----- ;Length of each line------10--------------- Total Length _2 ----1�.--•---- N J <br /> LEACHING LINE [ ] s ___-__ __-.- <br /> } D' Box . PJy--_ Filter Material _ '-__-_.__Depth Filter r Materiae zy�---------------------------------- <br /> Type _' <br /> Distance to nearest: Well -_--,)�--__-----_- Foundation ------ _--------__ Property Line =----..-- <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ <br /> il <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> P <br /> Distance tolnearest: Well -------------------------------------••-Foundation -------------------- Prop. Line .............-..------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------._--------------) <br /> Septic Tank (Specify Requirements) ---------------- ---------------------- -------------------- ------------------ ------------------------------�--- ----- <br /> DisposalField (Specify Requirements) ----------------------------------------------------------------------------------------------------------------------------I--------- C <br /> ---------------------------------- --- --------------------------------- <br /> --------------------------------------------------------------------------------------------------- --------- <br /> f-p - ----- <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 Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner orllicen- <br /> sed agents signature certifies the following: I <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 Copensation laws of California." r, <br /> I <br /> Signedx---- ----- ----------------------------------------- Owner W <br /> By ------------------- --- - - ------- ---------------- - <br /> ------------------------- Title --------------------- -------------------------------------------------- <br /> - <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE 7= ^ <br /> BUILDING PERMIT ISSUED ------------`------- ------- --------------------DATE --------------------- <br /> ADDITIONALCOMMENTS ------------ ----------------------- ------------------ -------------------------------------------- --------------------I <br /> ---------- <br /> ------------------------------------------- _ ------------------------------------------------------------ <br /> ---------------- ----------------------------------------------- --------- <br /> ------------------------------------------ ----------------------------------------------------------------- . i <br /> ---------- <br /> - <br /> FinalInspection by: ------------------------i------------:------------------------------------------------ __7__ Da#e - <br /> SAN JOAQUIN LOCAL HEALT DISTRICT <br /> G <br /> E. H. 9 1-'68 Rev. 5M � <br />