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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> / J. �i��4.-tvl_��.------ Permit No: __7 Z-:- <br /> «_ (Complete in Triplicate) <br /> Date Issued --_------- ------ <br /> This Permit Expires 1 Year From Date Issued <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 mode in comptlian ea it CounMd, an a No. 549 a d existin Rules and Regulations: <br /> --------------- ---------------`- <br /> ----- CE SUS TRACJOB ADDRESS/LOCA ION ✓L' _. __.:..---- , T <br /> Owner's Name ---- �. /�--/P �✓� /f _ _ _ <br /> 7 . <br /> P one . - <br /> Address -� Cit S '�6 <br /> - � v = <br /> 10fd -.License #9771j 7__ - Phone �s`Z 16------ <br /> " Contractor's Name -- -------- ' <br /> ---------------- ---- <br /> i � � <br /> Installation will serve: Residence partment House❑ Commercial []Trailer Court <br /> e Motel ❑Other ----------'-------------------------- ------- <br /> Number of living unitsNumber of bedrooms --3--..-_Garbage Grinder 1_.- Lot Size ^------ <br /> Water Supply..;Public System and name --(2� -- -- Private ❑ <br /> Character of soil to a depth,of 3 feet: Sand'❑ S'• ❑ Clay 4 Peat Sand Loam Cla Loam <br /> • Hardpan ❑ Adobe- fill N4aterial If yes,type ---------------------------- „ <br /> (Plot plan, showing size of lot' of of system in relation to wells, buildings, etc. must be placed on, reverse side.) <br /> '. [ <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' Size------- - -- ---- ---.7--------- = -----e.Liquid Depth - .--_-----___--_--- <br /> �} Ip Y'w. �Mr 3 <br /> r <br /> VCapacityType Compartments ------ .---------..... <br /> Distance to nearest. Well -----e '— -----..Foundation J �-J------------ <br /> Prop. Line -_.57i------------- <br /> - <br /> --- ---7:4=--------- Length of each line --- --- Total Length --�-�6 <br /> LEACHING LINE [ No. of Lines '-----•'------•-- <br /> 'D' Box °L..e-.s- Type Filter Material Avz.4 ------Depth Filter Material --J ----------------------------•---- <br /> .f ;� / <br /> Distant tonea __________ <br /> rest:-Well--___:_- ________Foundat-ion,/=.=_..-�---.--- -- Property Line-.\,S,--- <br /> I SEEPAGE PIT [ Depth -- ------ Diameter - 1-� Number -. -------------------- Rock Filled Yes ' No i❑ <br /> / I � 1i <br /> Water Table Depth ± ------------Rock Size --- } �z X <br /> Distance to nearest: Well ----------------------------------------Foundation -_H- - ----------- Prop. Line -­'�------ <br /> • f ----------------------- Date ------------------ <br /> 3 REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- - ----------- --- <br /> k (Specify Requirements) --------------------------------------- --- ---- --- - - ---------------------) <br /> ------------------------- <br /> Septic Tan ;--- <br /> Disposal Hild'(Specify Requirements) ----------------- ----------- <br /> ---------------------------_-------------- --------------- <br /> I-11 -------------- ---------------------- =--------- <br /> ----------------------------------------------- <br /> ---- -=------------------------------------------ <br /> ------------- -- -------------------------------------------------------- <br /> -------------------=--------- --------------- <br /> I hereby certify that I have prepared(Draw existing and required addition on reverse side) <br /> e in accordance with San Joaquin <br /> this application and that the work will be don <br /> County Ordinances, State Laws,..'and 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 become subject to Workman's Compensation laws of California." _ <br /> Signed --- --- ��.__u ' ------------------------------------j -=----- Owner <br /> + <br /> By ------------- ------ ----------- -------------- <br /> ------ Titled ----------------------- <br /> ',(If other.than owne <br /> }.� FOR .DEPARTMENT USE ONLY <br /> APPLICATION' ACCEPTED BY --------- ----------------- <br /> DATE ------1-- -�-j � `- ------ <br /> BUILDING PERMIT ISSUED -:_-- - DATE ------ <br /> -- --------- --------------------------------------------------------------------------- <br /> �� - <br /> ADDITIONAL COMMENTS �Q�/c_, ��P-------- -------- -- ------- �•f �,� _ <br /> ----------------- ----------------- �` ? ,_--/G�� � <br /> ,17 <br /> Final Inspection b ---------------------- ----------------------------Date �', ----------- <br /> y - --`------------------------ --- <br /> t SAN JOAQUIN LOCAL HEALTH, DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />