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FOR.,OFFI-gE,�USE: APPLICATION FOR SANITATION PERMIT <br /> 2, <br /> Permit No 7 <br /> -- - - -------------- <br /> --------------------------------------------------------- (Complete in Triplicate) <br />% <br /> -------------- --------- ---------------------------------- <br /> Date issued <br /> This Permit Expires 1 Year From Date Issued <br /> --------------------- --------------------I--------------- <br /> i. <br /> Application is-hereby to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> and Regulations-. <br /> described. This application is made in ompliance with County Ordinance No'. 549 and existing Rules <br /> CENSUS TRACT -------- <br /> JOB ADDRESS/LOCAT;'ION ----- -------------4_117ke.�Y_ _Y_f-------- --------------- <br /> ------------------- .----------------------------------- <br /> owner.s,:Nclme Phone V-11 1-WIx-t1co-----------------I----------­------ --------- ----------------- <br /> /17 -------1fV City ---t4 q--------------------------------- ...... <br /> Address 1219_0 77- ------------------------------- <br /> Phone ------------------------------ <br /> Contractor's ------------------------------------------------------------- <br /> ---License # <br /> Installation will serve: Residence V Apartment House❑ Commercial E]Traller Court 'El <br /> Motel E]other ---------------------------------------- <br /> Number of livi- <br /> ng. units:--_.__-_--- Number,of bedrooms --_?-- ---Garbage Grinder Lot Size --------------------------------- <br /> Water Supply: Public System and name ------------------------------------ -------------------------------------------------Private El <br /> Sandy Loam -El Clay Loam F1 <br /> Character--of soift-F—adipth'of.3 feet. Sand'ff�' Silt C1 Clay El ..Peat El <br /> clobef-I F I <br /> Hardpan El A' il Material ----- ------ If yes, type ---------------------------- <br /> 0 wells, buildings, etc. must be placed on reverse side.) 11%J <br /> (Plot plan, showing size of lot, <br /> location of system in relati nto we <br /> NEW INSTALLATION: (No septic tank-6-r—seep <br /> .pgq _W� <br /> -pit.permitted if pu,l�l seimer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK.[ ---------------- Liquid Depth --------------------------- <br /> ----------- - <br /> ------- Material ----------------- No. Compartments ---------------------- <br /> Capacity,------- --- ------------- <br /> I <br /> Distance to_nebr�est:.'Well -----------------------------------'-Foundation ---------E------------ <br /> Prop. Lin6 ---------- ----------- <br /> Itline----'---------------- <br /> f ------ Total Length ------------ ---------------- <br /> LEACHING LINE No. of Lines --------- Length of each lin6------ -------------- <br /> -Depth Filter Material -------------------------------------------- <br /> D' Box <br /> ' <br /> -------I--- Type Filter Material .------- --------- <br /> -Distance to nearest: Well ------------------------ Foundation:"---------------------- Property Line -------------- <br /> SEEPAGE PIT Depth ------ Diameter ------- <br /> --------- Numb6r --------------- <br /> -------- --- Rock Filled Yes E] No <br /> ---------- <br /> Water Table Depth ------------------------ ----------- ----------'-Rock Size ---- --------------------------- <br /> 4; <br /> '-Fo <br /> 6L ------- <br /> ndation -------------------- 'Prop. ine --------_--- --- <br /> Distance to nearest. Well -------------------------------------- <br /> REPAIR - <br /> /ADDITION(Prev. Sanitation Permit -------------------------------------------- Date -------------- <br /> ------------------- <br /> Septic Tank (Specify Requirements) ---------------------- -------------------- --- ------------- ------------------------------------------- <br /> _;F-S <br /> Disposal Field (Specify Requirements) ------------ ...... ---------------- -- -------------- <br /> ------------------------ -------------- ---------------------- --------------------------------------------------- <br /> ---------- ------------- ------------------------------------------------- . \1 <br /> ------------------- --- ---------------------------------------------------- -------------------------------------------------------------------------------------------------- <br /> fi------------­_­- --------- <br /> (Draw existing and required 4 dclition an 'reverse side) <br /> �V I <br /> I hereby certify that I have prepared this application and-th I at the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, Viand Rules and RegulcifidIns.of the Son Joaci6in Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> n such manner <br /> i <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person i. <br /> as to1*,Kb�rn subject to "kman'sACompensution laws�6f California." <br /> Signed _- ._�,. - -- <br /> ----------------------------- ------------------ qwner <br /> -Title ---------------------------------- ------------------------------ <br /> By -- -- - ---- ----- <br /> (If other than owner) <br /> FOR DEPARTMENT"USE ONLY <br /> APPLICATION ACCEPTED ---------------1�---------4------------------------- ---------- DATE ------------------ <br /> BUILDINGPERMIT ISSUED --------'------------------- ----------------------------------4r,-,--------------------------------- ---DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS .......... -----------------------------I— ------------------------------------------------------------------------------------------- <br /> :---------------------- --- ------------------------------------------------------------------------------- <br /> ---- -------------- ------------------------------------------------------- -------------------------------- --------- <br /> - <br /> -------------------------------------------------- -------------------------------- <br /> ------------------------------------------------------------------------------------ ---------- --- <br /> ------------ - ---------------- <br /> ---- - ------------ ------------------� -----------------------------------W-------------------------- -------------------------K------I--------------- <br /> FinalInspection by: ----------------------------------------------------------------------- ------Date -------------- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68-Rev. 5M <br />