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.--` FSR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 44t, ' <br /> Permit No.7 :.r .l��.• <br /> ............... •�•.._.. (Ccatpletaln Triplicate) <br /> 11 <br /> ............... ............ .. <br /> Date Issued .../..�.`..•�=.'��•-. <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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulationst <br /> JOB ADDRESS/LOCATION .-.. ..3.,.- ,- s,2 .............................CENSUS TRACT .......................,.. <br /> ' Phone . <br /> Owner's Name t. .... lrr�r... ...........................-.-..:..,............. ................_............. <br /> Address �.�1 w .. ... Cih+ a"`' -. ......... <br /> Contractor's Name �, ►` .........................License # _-.-.. Phone ... .. .. ... .. ..�� <br /> Installation will serve: Residence Apartment House Commercial❑Trailer Court ❑ <br /> Motel:[I Other ------------------------•------------------- 2—J <br /> Number of living units:---/------ Number of bedrooms ..::Garbage Grinder ..... ...... lot S/i�e ___�_ � <br /> '` -.._ � � <br /> (. <br /> Water Supply: Public System and name ........----•-----... ... . .. ---A`i.....'m--- ".............-private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peatb 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 /> PACKAGE TREATMENT [ I SEPTIC TANK ] Size----------------- ----------•--••----------- Liquid Depth ------.-----­------------ <br /> Capacity Type ------- Material---------------------- No. Compartments ........ •---........%. <br /> Distance to nearest: Well -----...............-.----------....Foundation ------------•--------- Prop. Line ---------_-••-- --- <br /> LEACHING LINT; [ } No. of Lines ----------------- <br /> ------------ Length of each line_....---------- .......... Total Length ............................ <br /> 'D' Sox ...'Type Filter Material •_Depth Filter Material ............................................ <br /> Distance to nearest: Well ..............------.... Foundation .....---................ Property Line ........................ V) <br /> SEEPAGE PIT [ Depth .••• Diameter ................ Number ---------------------------- Rock Filled Yes ❑ No I❑ . <br /> Water Table Depth ------------------------------ -----------------Rock Size ............. ------------ <br /> Distance to nearest: Well ------------------ ...----•••.Foundation -------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prey. Sanitation Permit# -------------------------------------------- Date -----.._-- _--------_------••-) <br /> Septic Tank (Specify Requirements) ........... .......................................... ..............I..................,...... •� <br /> Disposal Field (Specify Requirements) ............................ -------.:--------------------------------------•---•._........... <br /> -. <br /> ------------------------- -- �C_ .--..... ._... -.�.- -G. -------- --...._..--..... ------- -------- <br /> s <br /> ----- ----------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that l have prepared this application and that the work will be done in accordance with San Jeaquin <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 /> "1 certify that in the p once of the work for which this permit is issued, 1 shall not employ any person In such manner <br /> as to become subject to Work an's Compensa �fuws lifornia." <br /> Signed ----. <br /> By ---------------- .Title --•- .--• ......................... ----------------------- ---.- <br /> (.If other than owner) <br /> FOR DEPARTMIENT�JJSE ONLY <br /> IL <br /> APPLICATION ACCEPTED BY ----- ----------------------------- - --•--- --i --- - - ....... DATE ...�1``5: �- ------- ---•-- <br /> BUILDING PERMIT ISSUED . DATE -+ ............ <br /> ----------- -- --- ----------- .. .---- .. .- <br /> ADDITIONALCOMMENTS ----. ..-------- -----------------------------------•--------- N .........--..... <br /> ---------•------- --------- --------- • ------------. ------t.........-- ........................................................... <br /> .-......--.....-.-. <br /> ---------------------------------------------- -------------------------------------------- <br /> ...... ..i. ........ ................ <br /> final Inspection b -.Date .....'. .............. ................ <br /> EH J-3 24 1-68 Rev. SAN JOAQUIN LOCAL EALTH tSTRiCi 8/74 3M <br />