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yr FOR OFFIC USE: <br /> .--�--------- h-P.. - f j�; ha <br /> APPLICATION FOR SANITATION PERMIT <br /> 1 <br /> (Complete in Triplicate) Permit No. <br /> ------------- ---------------------------------- --- ---- This Permit Expires ] Year From Date Issued Date Issued 4_4__7P <br /> Application is hereby made to he San Jo Local Health District for a permit to construct and install the work herein <br /> describe T ' ication is in c iance ith Co my Ordinance No. 549 and existing Rules and Regulations: <br /> JOBR�'L TI <br /> / ------- - -CENSU <br /> -- -- -- -- ----- Y- axz--) 5 TRACT <br /> Owner's Name _. <br /> t__ <br /> C�• <br /> / � - ----- .Phone .-/.----- e� <br /> Address CeL� City <br /> Contractor's Name -..__ - _ _-.License # - �J_ Phone <br /> ---- ------------------- <br /> Installation will serve: ResidenceXApartment House-E. <br /> Commercia ❑Traller Court <br /> Motel []Other"t I <br /> f Number of living units: -.__._. Number of bedrooms _ -Garbage Grinder#".,__- __ Lo't5ize <br /> Water Supply: Public System and name __ _ n "d"�"""`;I <br /> ------------------------------- ---- ------ Private <br /> Character of soil to a depth of 3 feet: Sand.'❑ Silt❑ Clay ❑ Peat C] Sandy Loam ❑ Clay Loam <br /> 4 Hardpan ❑ AdobeX Fill Material ..----.-. If yes,type ------------F--_._________ <br /> (Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) W <br /> NEW INSTALLATION: I <br /> {No septic tank or seepage pit permitted if,public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT <br /> { j SEPT TAN Size-/-- --/C�f----------------- Liquid Depth .----41--------------- <br /> Capacity,<{,7�Q_0------ Type /LQt_ Material----- -. ----- No. Compartments ---�- <br /> ( i � <br /> Distance to nearest: Well - -_ -_-_--_Foundation _/_d�_---.------- Prop. Line -----�_. <br /> LEACHING LINE No, of Lines __.- �" ' e <br /> -- _---- - Length of each line Uh �17-Q------------- <br /> --- - - ,� -----_ r�Q".-_ Total Len th <br /> 'D' Box -_ __.- Type Filter Material �1ev�_Depth Filter Material --_� <br /> Distance to nearest. Well _el _ Foundation `-` _ '"_"""""Property Line. <br /> SEEPAGE PIT Depth �---__-_--_ DiarneterZ�U-_----__- Number --------- <br /> s � - ----_-�_-- Rock Filled Yes No � A <br /> Water Table Depth ------.��-------------------------------(tock Size --{�--+✓� ---- � + <br /> - , a N-1 <br /> Distance to nearest: Well _. { ---_________________..Foundation �/_.C1Z-------- Prop. Line . l/rpt, <br /> r <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------ ------ Date ------------------------ <br /> Septic Tank (Specify Requirements) <br /> - - ------------------------------------------------------- <br /> Disposal Field (Specify Requirements) ------------------------ ' <br /> I e <br /> - ---------------------------------------------- <br /> - ---------------------------------------------------------- <br /> -------------------------------------------------- <br /> -------------------------- -- --- <br /> - ------------ -------- —10 <br /> ------------------------ --- <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 I <br /> County Ordinances, State Laws, ani( Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the fallowing: <br /> "I certify that in the performance the work for which this permit is issued, I shall not employ any person in such manner I <br /> as to bec - s ecT'to rkma (Compensatio`iiiAwg of California." <br /> Signed -- ---- - ---- - <br /> - ----- -- - wrier <br /> ----------------- <br /> sY i <br /> ifle -------------- ----- <br /> other than owne <br /> - <br /> -------------------------- <br /> ----------------------- <br /> (IfO TMENT USE ONLY <br /> APPLICATION ACCEPTED By----- -- ---- - <br /> BUILDING PERMIT ISSUED -.--.-- DATE _.. _. -, '--_ ._ <br /> Q <br /> ---- ----:--------------DATE ------------------------------------------- <br /> ------------- <br /> ------------------- <br /> DITIONAL COMMENTS ---- -- --------- --- -- - --------------- ------ <br /> ------------ ------- --------- ---------------------------------- ------------- ----------------- ------------ <br /> �-- -------' /r--p--�- -- i--- - --- ----------------------------------------- <br /> --------- -- - - - --- - -----'�-1-. �--------- - --- - ---------------------------- - <br /> FinalInspection b - ------------- ----- ----- ----- ---- - --------- ------------�,-------,_:- -- ----- <br /> p Y- -- - --------------Date d <br /> - ---------------------- ------------------------------ - <br /> JOAQUIN LOCAL HEALTH DISTRICT J <br /> E. H. 9, 1—'68 Rev. - ' <br />