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FOR OFFICE USE: <br /> �9APPLICATION FOR SANITATION PERMIT <br /> 3� -x----------------- <br /> 114411-1----------- I Permit No: <br /> (Co m plete in Triplicate) <br /> , <br /> ----------------------------------_---- ------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued __ ..'_Z�_-�_v <br /> ki <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 's made in c mp 'a c wit C u.ty dice Ng�549 and existin Rules and Regulations: <br /> J08 ADDRESS/LO ATION ` � ------ ------ ----------- ---- ------- -- CENSUS�RACT -------------------------- <br /> Owner's Name ------ m --- ---------M, A4JI------------------------- -------------------- --------- ----------- -------Phone ----------------------------------- � <br /> Address ------ ------ -- ------3-9-�-�----- i Ct -------�-------------. City S -------------....---•- <br /> Contractor's Name __P, f----- License # 7�-��: Phone <br /> Installation will serve: Residence ['Apartment House-[] Commercial ❑Trailer Court ❑ , <br /> 1 Motel ❑ Other -------------------------------------------- <br /> Number of livin units: Number of b drooms Garbage Grinder _____ Lot Size <br /> g rr g <br /> Wate'r`Suppl' : Public System and iname -- _-- _-- ��i ___ ---------------------------------•---------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt EJ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material 411�9_ If yes, type _______________________---- <br /> Mot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on revers;-side.) 6N <br /> NEW INSTALLATION: (No septic.tank or seepage pit permitted if public sewer is available within 200 feet,) /� <br /> PACKAGE TREATMENT I ] SEPTIC TANK' ize r _ Liquid Depth _ /_ ____________ <br /> C� -f c - . <br /> I , Distance to nearest: Well ________--- ___________Foundation1�� p l ct <br />. -- ------- Pro Line _�--------------- <br /> LEACHING LINE [ No. of Lines ---��-- _------_ Length o each ine.__ j_/��_._____ Total Length _-_!___-__.___ <br /> -- -'D' Box _ --_ Type filter Material ------------Depth Filter' Material _ <br /> Distance L' nearest: Well ----------"--�---------- Foundation --------- Property Line _` ---------------­- <br /> ---- <br /> .........:.... <br /> SEEPAGE PIT [ Depth --_-----_�.r____ Diameter_�-- Number ---_---- _.___-__ Rock Filled Yes No i❑ <br /> i Water Table Depth -------�-----------------------------------Rock Size -- -A4_11� __----.---- <br /> Distance to nearest: Well -----------------------------------_....Foundation ---1___1________ __ Prop. Line .__..._.____.__ . <br /> -�. <br /> _ I <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------------------.-1 <br /> 1 _ - - -- - .- <br /> SepticTank (Specify Requirements) '-------------------------------------------------------------------------------------------------------- ..__...----=-----•--•-_-------- <br /> k Disposal Field (Specify Requirements) ------------------------------ -------------------------------------------------------------------------------=---------------------- <br /> - ---------------- - ------ -----`---------------------------------------------------------------------------=- ------------ --------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------:--------------------- <br /> j (Draw existing and required addition on reverse side) <br /> f I hereby certify that I have prepared this application and that the work will be done in accordance with San 'Joaquin <br />{ County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Locai Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> Q "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 /> r Signed - --- -- ----------------- = - --------- -_- --: --- Owner - <br /> i - <br /> $ -----------=--------------------------------- - i ----� � -----,'-- Title --- -7--- ------ <br /> ------------- <br /> F (If other than ow�L # <br /> i. FOR .DEPA1tTMENT USE ONLY <br /> APPLICATION ACCEPTED BY______________ __________ t J <br /> DATE <br /> BUILDING PERMIT ISSUED . �° --------------=------------ ------------------------------DATE -------------•---- ------------------------ <br /> 01k__ <br /> -•--------------- ---- . <br /> ADDITIONAL COMMENTS-_-'t a=-.-- a � `_ 7 x�- ----------------------------- r <br /> s _` -- - --------- <br /> ----- _ <br /> -- -- --------------- --------------------------------- -° " <br /> t ------------------ ----------------- --------------------------------------------------------------- ----- --- _ -----------_------ <br /> Final Inspection by: - ---------------------------; -------------- ---•--------- ------------------------------Date_ . -------- <br /> i <br /> I SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> f <br /> E. H. 9 1-'68 Rev. 5M <br />