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FOR OFFICE USE: A _* <br /> N. <br /> APPLICATIO,�V FOR SANITATION PERMIT------- �' y rPermit <br /> j (Complete in Triplicate) <br /> ----- ---- ------------------------------------- <br /> ' <br /> ------------------------------ This Permit Expires 1 Year From Date Issued Date Issued ._F- -----V7 <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' <br /> in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .3_7_. `� IF----- -f✓-r�9-- <br /> _ ------------------- ----- -------------------------CENSUS TRACT -------- ------------- <br /> ' � � <br /> Owner's Name ._Jr{/�� --�f_�-eJY�,` ----------------------------------------------------------------- Phone - ----- ---- 7°24- ---- <br /> Address ...... -------------------------------- Cit mrd c IcJJ----- ------------------------------------•-- <br /> Contractor's Name _�9� ------- .License # ----- Phone <br /> Installation will serve: Residence ❑Apartment House❑ Commercial, ilet Court i❑ <br /> Motel ❑ Other ----.__-----_______---- <br /> Number of living units..--- Nu'mber of bedrooms ---C------Garbage Grinder _/Yd--- Lot Size _d9�_l'le----------------------- -- <br /> Water Supply: Public System and name -------------- ---------------------- --------------------------------------------------- ------------Private [Z_ i <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan F j Adobe 2�-- 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.) W <br /> NEW INSTALLATION: (No septic itank or seepage pit permitted if public sewer is available within 200 feet,) U <br /> PACKAGE TREATMENT [ I SEPTIC TANK Size.6---- '--------------- Liquid Depth _-y_-______.---,----- <br /> Capacity / 4.� �Type �r9 �` Material No. Compartments __ _______________ <br /> Distance to nearest. Well ------�_Q---r__________________Foundation ----I-0 -------- Prop. Line -__ ............ <br /> r <br /> LEACHING LINE [ No. of Lines -------/--------------- Length of each line----//a------ <br /> ----------- <br /> Total Length ___--------------- <br /> 'D' Box --- --- Type Filter Material --------------------Depthj Filter Material -------------------.------------------------ <br /> ,; <br /> Distance to nearest: Well --------------Foundation4------- ____________ Property Line ,___.____----___._____..-�, <br /> SEEPAGE PIT [L�-- Depth _._ Diameter ---3.3------ Number ------- ----------------- Rock Filled Yes [�--No <br /> -------------- <br /> i, <br /> Water Table Depth 1Q� -------------------------- Rock'Size <br /> Distance to nearest: Well ._._-/6!_0____-- _-_- Foundation ----/_0___`----- Prop. Line ____S_ ----- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- pate --------------------.-----------•--) <br /> SepticTank (Specify Requirements) -------- ------------------------------------------------------------------------------------------------------ ------ -------------------•• . r <br /> Disposal Field (Specify Requirements) --------------------------------------}---------------------------------------------------------------------.---------- 1\ <br /> ------------------------------------------------------ ---------------------------- -------------------- - -------------------------------------- --------------------------- ------------------------ f- <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 /> an <br /> County Ordinances, State Laws, d 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 becom subject to Workman's Compensation laws of Californic." <br /> nn 4 <br /> Signed - ' ------ -x------------- -----------------------------------------" - Owner <br /> BY ---- ------------- --------- --------------------- Title ---------------------- ------------------- -- ------------------ ------ <br /> (If other than owner) `r <br /> FOR DF.I'ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ._.____�__ DATE _.___ <br /> -- - -------- - <br /> BUILDINGPERMIT ISSUED ---------------------------------- ------------------------------'----------------------- --------------DATE ------------------ <br /> ADDITIONALCOMMENTS ----------- I--- ---------------- ------------------------ ------------ ---------------------------------------------------- --------------------------- <br /> ------ --- --- ---------------- -------- ------- ----- ----------------- ---- -------------------------------------------------- ---------------------- <br /> Final Inspection by --------- Date __. _ 1- ------------------- <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> k <br /> E. H. 9 1-'68 Rev. 5M. "` <br />