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FOR-QFJ✓iCf_U5E:.._ - -- - APPLICATION'"FOR 4,�ANITATION PERMIT <br /> ttiPermit No.-------------------------- `(Coirsplete in Triplicate) <br /> ____________________E.___-_.____ ----------------------- <br /> mit: <br /> i Date Issued /L-_ - -_-7.. <br /> Thi Per Expires 1 Year From Date lssu`ed, <br /> Application is hereby made to the San Joaquin Local Health District foria permit to construct and install the work herein <br /> described. This application is made'in compli nee with County OrdinanovNo.'54 an'-x sting Rul n Regulations: <br /> t _�. .. ------ <br /> ION <br /> . ---CENSUS TRACT ------------------------ <br /> ' '- , � <br /> JOB ADDRESSAOCATiON -- _ <br /> -:�--.� , - - �, ,. .. Phone --- --------------- •------- <br /> Owner s 'Name - - -------- <br /> -------------- <br /> = City -- <br /> Address ---`-`-------------- !=` } �( ` <br /> € =- ------License # --------- X_- Phone� - <br /> - -- <br /> Confiractor,�Name _-- -_----- "i ❑ ' ---- -t\ ,� 4: ,� I :❑Trailer ---- - s x- <br /> +`` Residence Apartment House.❑i-Commercia Court ; <br /> Installatior��w�l serve: Motel Other•---------------=---�_�-----_�- ^ �•r I <br /> ---Residence <br /> yJ / ----------- <br /> Number of,living units:' .__, Number of bedrooms __-3_�Garbage-' cinder--�---_ tat Size----------------- - <br /> 1 <br /> •, a _---P_r.Nate_. <br /> Water:Su. I PubIic.5 ste:.,and:name------ ---------------==--- ----------------- <br /> pP y:� Y t _ <br /> Character of soil tam depth of 3 feet: Sand'❑ Silt❑ Cray❑-�P�aS°naY Loam T] J�Cy Loam ❑ <br /> ' Hardpan ❑ Adobe Fill Material ------------ if yes,type ---------------------------- <br /> of 1t-location of system nrelation to wells, buildings, etc. must be placed on reverse side.] <br /> {Plot plan, showing size -:z t., <br /> NEW INSTALLATION: (No=sep�'tank or seepage pif,,permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT i ] i4 SEP�TIIC TANK'[ l Si.ze----------------------------- -------------- Liquid Depth <br /> No. Compartments --------- <br /> Capacity Type Material - 1 <br /> 3 <br /> Foundation Prop. Line <br /> g� M Distance to nearest: Well <br /> r , ------- Length:of each line--------- ----------- Total Length > s ••---••--•-------- <br /> LEACHING LINE [ ] No. of Lines l_.--_____._ <br /> D' Box .---___'__.- Type Filter Material;_____-----____-- Depth Filter Materia , , <br /> i ce_tn€earest: Well _________________1__ --- Foundation _..-------___ -- Property Line. ------- ------------ <br /> Dispdn, � q <br /> SEEPAGE PIT [ ] Depth;.,- k' i Diameter ---------------- Number ------------------------ Rock Filled Yes ❑- N \ <br /> i Water Table 'Depth E----------- - - -----Rock Size -----------------• _-----_----- <br /> Distance to nearest: WWI __________________ <br /> --------------Foundation -------------------- Prop. Line ---•--- { --- --- J <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _..---- ----- <br /> ---------- Date ------------------------•---------) <br /> 5epfiic Tank (specify requirements)_---------- ] r------------------------ �f3 <br /> D .- ____ -- - ------------------- •------------- <br /> --- -- ----------------------- -- <br /> ------------- <br /> posal Field (Specify Requirements} --__ - •--•----• f <br /> -------------- <br /> Disposal _ <br /> ----------- <br /> 71 =--------- <br /> f <br /> _• f _ --------------------- <br /> -------------------------------------------------------------------- _________----_._____--________--_____-____-._______--_______----___-__-_-____-__-.-___- -- ----------- <br /> ---------- ------- --------- <br /> � (Draw exisg and required addition on reverse side) ; <br /> � I"hereby certify that .I have prepared this appmlication and"that;the work will be done in accordance with San Joaquin <br /> bf the San Joaquin Local Health District. Home owner or [icon <br /> County Ordinances, State.Laws, and Rules and Regulations - <br /> 3 sed agents signature certifie> thetfollowing: ` <br /> "1 certify that in the performance Iof 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 <br /> •------ Owner <br /> -------------------- ---------- - <br /> ------------- ------ Title ------ <br /> ----- - - -------------- ------------ <br /> By <br /> ------------- <br /> By --------- { <br /> (If oth r han owner) <br /> F F FOR -DEPARTMENT USE ONLY <br /> / ,.. DATE _.fl'- ---7 ' <br /> APPLICATION ACCEPTED BY ------- - - <br /> DATE - -------------------------- ------------ <br /> BUILDING PERMIT ISSURD -------_L----------------------=--------------------- - <br /> ---------- ------- <br /> ADDITIONAL COMMENTS ----------`------------------------------------------------- ---------------------------- ----------------------- --- <br /> t ---------- <br /> ---------------•--- . <br /> -_ ` -------------- <br /> ---- ----------- <br /> z <br /> ------. <br /> Final Inspection by: ------ ---------•-----•------------ <br /> ---------------------------Dat <br /> e _ <br /> -- <br /> SAN :JOAOUIN�LOCAI,_;HEALTH DISTRICT <br /> € <br /> E. H. 9 1-'68 Rev. 5M <br />