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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------•_...... <br /> (Complete in Triplicate) permit No- --------------------- <br /> ; ��.%--=�� <br /> :......................... This Permit Expires I Year From Da_te Istaed bare Is:ued <br /> Application is hereby made to the Scn Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. This application is made in compliance with County Ordiriariee No. 549 and iii'sting Rules and Regulations- <br /> JOB .. . � <br /> JOB ADDRESS/LOCATIO Q. .................................CENSUS TRACT .......................... <br /> Owner's Name .......... 4_4------ �.................... <br /> ...................... ......... .... ..Phone ..........._. .. .. .. .. <br /> Address .............. ... city ..:..........__.. .................... _ <br /> _ ............... ......... <br /> • 7 <br /> Contractor's Name . ---------- <br /> . ... 0`u ... License # J ..3j.... Phone6 _�7i?4.l <br /> Installation will serve: .. . _Risidence�§_Apartment_House❑-Commercial [ Trallor.Cou' <br /> Motel []Other <br /> Number of living units:..... __..__ Number of bedrooms .../........Garbage Grinder .... Lot Size s......�i�.. -Q.............. . <br /> Water Supply: Public Sys#em and name ------------------- -----------------•.........------------.-------..............._.................Private 0. <br /> Character of soil to a de't'th of 3 feet: Sand Silt Cls Peat Sand Loam C[a Loam l <br /> p ❑ ❑ Y ❑ ❑ Y o. Y ❑ <br /> Hardpan 0 Adobe fill Material <br /> ....... If yes,hype............... ............ <br /> (Plot plan, showing size of lot, locationf sysfem-in.relation to wells, buildings, etc. must^be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f ] SEPTIC,TANKI ) Size..............:..:..: ...... Liquid Depth <br /> r �- « n•Capacity ----. Type ---------- -- Material .�` ....... No. Compartments ...................... <br /> r T <br /> Distance to nearest: Well ..... ................Foundation ...................... Prop. Line <br /> LEACHING LINE No. of Li <br /> [ ) nes ----------_--•--------Length of each line................. ----....... Total Length ............................ <br /> 'D' Box � Type Filter Material ..Depth .Filter Material <br /> Distance to nearest: Well ------------------------ Foundation _....................... Property Line "' <br /> SEEPAGE PIT ( ] Depth'_._11---_- -_ _- Diameter __- ......... Rock Filled Yes [J No Q <br /> Number __.._.. <br /> Water Table Depth --- ---------------•--......---.-.------•-- ----Rock Size ................................. <br /> Distance to nearest: Well __....Foundation ..... Prop. Line <br /> t <br /> REPAIR/ADDITION(Prev. Sanitation. Permit# ..--.•.-... - - -------------- - Date ................................ <br /> ..) <br /> Septic Tank (Specify Requirements! --- ....� _-- ------. � ........................... -C.ctiQJL.............. <br /> ....................................... . <br /> Disposal Field (Specify Requirements) ---- /_.----...............------------•_ _--- ............... <br /> I <br /> --------------------------------------------­-.._..----------::-----------•-- --••-•----•••-•---•-----------------------------...-•-•--------------•------••------- ..................... <br /> --------------------------- ---------------------&____1 I <br /> -----------------------------------------------------------------------------••-- - -------------------------------- <br /> .......... <br /> .................... <br /> I(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 <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;Dlstrict. Home owner or Ilcen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance-of the work for which this permit is issued, I shalt not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------- -----------• -•.r_... . ------• ------------------- ------ Owner <br /> BY ( he t n owner} - - - ------------------------------------- Title ----- -------------------------------- <br /> FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED BY ----------------.---- --------- DATE ------- <br /> BUILDING PERMIT ISSUED .. ... ... ' _ DATE - ------_------------- <br /> ADDITIONAL COMMENTS �,z[ lI�G.. �.fi-._• ��� <br /> L .. <br /> ---------- ------------------------------ -----------• - •,M <br /> ------------- - -------- ------------------ <br /> Final inspection by: ... _._.._._.__.._.. .................:...Date ....EH .. .,; <br /> 13 2L 1--613 itev. 514 I SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />