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` <br /> FOR OFFICE USE: 75 16� <br /> ° A PIiICATION FOR SANITATION PERMIT <br /> ................... Permit No. .7 ...: <br /> (Complete in Triplicate) <br /> ............... This Permit Expires 1 Year From Date Issued Date Issued 7S <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 /> -.. - , <br /> JOB ADDRESS/LOCATION .... .". �t ._ .:... - ..... ...CENSUS TRACT ..........:............... <br /> �9 <br /> Owner's Name ..:..� __L.��_��...� �.. .......-•-----•---------- -------------......-----... .Phone <br /> ..............Address • . City . .............................. <br /> Contractor's <br /> Name ..... 7..._.. : r.•_.. ./-C> ....................License #� '"_ /_'7: Phone <br /> Installation will serve: Residence Apartment House❑ Commercial [)Trailer Court <br /> t <br /> Motel ❑Other -----------------------............... <br /> ••--•- <br /> Number of living units:.../....... Number of bedrooms ..._.__.Garbage Grinder ___-____._-. Lot Size .___.__ r ..........: i <br /> Water Supply: Public System and name --•- ------..._ .....--•--..........-------------------------------•---------------'----_-------------#---.Privote <br /> Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ Peat❑ Sandy Loa ❑ Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,ty a ________________ __�___._.. <br /> (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. m st be placed on reverse side.) <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ Size_........................................... . Liquid De�th ........................... <br /> Capacity _,l ' a_.__. Type .4... Ggidf—Material N . Compartments ...>-.-e-------------- <br /> } Distance to nearest: Well .__-.. .!.n...................Foundation .... ...... ......- Prop Line .... <br /> LEACHING L1 E [ ] No. of Lines ______ Length of each line-----yjdlol <br /> ............. Total Length".' . <br /> . .i........... <br /> D' Box ,. Type Filter Material ! .�5......Depth Filter Material ! ' <br /> -- ---Distance-to.nearest:WeJJFoundation=?- -.:� :.__. Property eine ............ .......• G <br /> '=- C <br /> SEEPAGE PIT., [ ] Depth -------------------- Diameter ................, Number ..._.. ....... Rock Filled Yes C1 No Q <br /> Water Table Depth •-----...:s-•-• -_- -•- -•. .----------•-- -----Rack Size --------- -- - - _- <br /> J <br /> �. <br /> - --•..----•.................. ..... .------------__---- pLine --------------Distance to nearest: WellProy ....__._ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........ :.................................. Date --••....•............. ...........1 ' <br /> Septic Tank (Specify Requirements) ....----_----•-----#.............................................................•.............•.................. .................... <br /> Disposal Field (Specify Requirements) .............#. ---- --.-----t------_------.------I---------- <br /> ' <br /> f <br /> # I <br /> f [ <br /> t (Draw existing;and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application d'that the work will be done insaccordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of`the San Joaquin local Health District. Home owner orlicen- <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 haws of California." <br /> Signed �. ,.a., ... �. .�,. .� .-�.._.:....... ner � --• --�--- �' '� <br /> - x <br /> ------------------------------ <br /> By <br /> ---- -----------------ay A4- ---- , _ -- --- -- ------- Taitl^e+ <br /> ....: ................................................................. i <br /> (If other than owner) <br /> AIN U FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---- ------ -------- ---- ---------------------------------•--------------.....---------------_. DATE ...... .. 3.:7 .......... <br /> BUILDING PERMIT ISSUED ... ...DATE <br /> ADDITIONAL COMMENTS ----------••------•--------------------------------• --•------- ---------------- ......................................................................... <br /> .. <br /> Final Inspection by: Date ........... ....--......._......_...._.... <br /> - � SAN JOAQUJN LOCAL HEALTH DISTRICT <br /> r- u 13 24 , 7179 1 M <br />