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FOR 07W USE: a , <br /> APPLICATION FOR SANITATION PERMIT <br /> T <br /> - �-----------------•--------------------- �. � , Permit No: <br /> (Complete in Triplicate) ----------------•-- <br /> _______-________-. This Permit Expires T Year From Date IssuedDate Issued / -�'l�'. <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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> �`x Cdr fa t, i <br /> JOB ADDRESS/LOCATION .__eG'_ ---f - ---- -���Y__ '�/J- ' '-------[- -----CENSUS TRACT -------------------------- <br /> :5- <br /> Owner's Name .-----//z'' i�� �'--`- i'c� /��Jl - --------------Phone -------- <br /> ,? <br /> Address ----- .......3 W � � --------------------------------------------- - City --IL"t- �� �� f <br /> n , <br /> Contractor's Name ---_*_Dt9-'"A-------- -----------License . -f- ------ phone <br /> Installation will serve: Residence ❑ Apartment House❑Commercial ❑Trailer Court';❑ <br /> Motel ❑Other _! (p <br /> 4' <br /> Number of living units;-----/---- Number of bedroomsF----2___'_Garbage Grinder ✓�� ;__ Lot Size _.__. __`�_ _____ ________ <br /> � 1 ' <br /> Water Supply. Public System and name ------ ------i '` ----------- -------------------------`-----------------------------------Privater[ l <br /> Character of soil to a depth of 3 feet: Sand' Silt D Cla.y_❑—]Peat❑ Sandy Loam •❑ Clay Loam '.0 <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ________________________ <br /> (Plot plan, showing size of lot, location of systeim 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 [ ] SEPTIC TANK Size_ _ '�✓_YC1.�r�________________ Liquid Depth ____-- _.7�_------------- <br /> t <br /> Capacityf0Type�� �- ✓- Material �r±rr' f� No. Compartments __ -__..._ ._ <br /> i �.. <br /> Distance to nearest: Well ____ _ ______________________Foundation __��__.____.____ Prop. Line __-__`+�______________ M <br /> --- i ® -------- Total Length ----`AP----------•- <br /> LEACHING LINE � No, of Lines -�____ _ Length th,o each line_______ _______ _ f <br /> D' Box __/-------- Type Filter Material Depth Filter,, Material ------l_P_______________________ <br /> Distance to nearest: Well Foundation _.__/_0_ ----------- Property Line ----- ____-__.-__ <br /> SEEPAGE PIT [ ] Depth ------ Diameter ---------------- Number _ -------- _________ Rock Filled Yes ❑ No 0 <br /> it <br /> Water Table Depth `j-------------------------------------=--------Rock Size --- ---------------------------- <br /> Distance to nearest: Well -------------_---------------------------Foundation ------------------- Prop. Line -....-...._______ ._ t�— <br /> REPAIR/ADDITION(Prev. San itation_P_ermit#_.._W-_:._---------------------�'------ Date ------ -_----_------ ) � <br /> Septic Tank (Specify Requirements) ' ---- ---A ----- ------------------------ <br /> --- -----------------f Y---------------------'---�{------------- ---------------,_--------------------------- lf� <br /> Disposal Field (Specify 4equirements)7---2l'_p//-A _5"V. -� ------ 2'___--- �____` ________ <br /> ' -- - 'di - ------------- --- G <br /> x «f <br /> (Draw existing and re uired addit _ I <br /> ------ ---- -------- ------------------------ ------- --- ----------- --------- <br /> ------------ -- ----------------------------------------------------------------------- �.-------- ---=-------------------------------- <br /> - ---------------------------- <br /> � ` �q---- r»-�-aon on-reverse side) <br /> I hereby certify that'l�haxe-prepared_this_application and.that_lthe work will done in accordance with San Joaquin <br /> County Ordinances, ittate'Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature-certifies the following: i <br /> "1 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 s ject to W"man's Compensation laws of California." i <br /> Sign el� <br /> �� Owner <br /> B � ---------- - -- -��----------------------- Title G ?* -��------- ----------------------------------- <br /> if <br /> .�/ -------- i <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY, 1 <br /> r <br /> APPLICATION ACCEPTED BY .------_- X_- Ij ---1-_---- DATE --------�� ` f0- may- <br /> --- - - ---- - ----- ---- ---- ---- - _ <br /> BUILDING`PERMIT ISSUED ----------------------------------------------------------------------::--------------------------}--------DATE -------------------------------------------- <br /> ADDITIONAL <br /> ------ ---------------------------------- s <br /> ADDITIONALCOMMENTS --------------------------------------------------------------------------- -- -------------------------- --------------------------------------------- ------ i <br /> -------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------•- <br /> -------------------------------------------------------- ------------ -- - - -- <br /> Final Inspection by: _a. <br /> ---- ----- ----- --- ------------ l Date 1 - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT = ; <br /> E. H. 9 1-'68 Rev. 5M <br />