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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT J <br /> ........................................... Permit No. ...7 :. 3 <br /> (Complete in Triplicate) <br /> F 2 y 7f6 <br /> _ Date Issued .......... <br /> ................................:....................... This Permit Expires IYear 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 made in compliance unty Ordinance No. 549 and existing Rules.and Regulations:' <br /> JOB ADDRESS LOCA 10.6 .CENSUS TRACT <br /> Owner's Name ....Phe e „ <br />!, .. .. . .. . <br /> 1.� :. Q . ....... <br /> 0,0 <br /> AddressCity ....................•----...._------------ • . ............. ... - <br /> ..�.. <br /> Contractor's Norrie ....... ... . . . . ---- ... ..._._.-- --_:- -G�.. .. .-License # -/_8-ff 3'9 done <br /> Installation will,!serve: Residence A artment House Commercial ❑Trailer Court fl <br /> Motel ❑Other . <br /> Number of liviA <br /> g units:...... <br /> Number of bedrooms ....Garbage Grinder --____.-_-- Lot Size ....:.... ................ ............... <br /> Water Supply: Public System and.name.--........_...--•----•----------- --.`_.:...--- ..::.........................................Private <br /> Character of soil to a depth of 3 feet: Sand VAtdl <br /> Clay [3 -peat(] Sandy.Loamfl ClayLoamo <br /> Hardpan ❑ Fill Material ............ If yes,type ..................{-......... <br /> (Plot plan, showing size of lot, location ofsystem inrelation to wells, buildings, etc. must be placed on reverse side.). <br /> NEW INSTALLATION: (No septic tank or seepage pit perm7tted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK,[ ] Size--------------------------------------------- -- Liquid Depth ..._... ........ J <br /> Capacity ----------------••-• Type <br /> .••. -..:. �_... Material...................... No. Compartments ............-........ <br /> Distance to nearest: Well .__... ...................•__..._.._Foundation ------..__............ Prop. Line . <br />[ � ( l No. of Lines ......................... <br /> Length of each line.._________----._ .._... -. ...- <br /> Total length :___ --........•: <br /> LEACHING LININ __ ,.__. O <br /> 'D' Box Type Filter Material ....Depth Filter Material <br /> aw Distance to nearest:-Well ....................... Foundation .---_------------••_-- Property Line- .................... Z <br /> SEEPAGE PIT F.) ' Depth Diameter ►•ISluri beir ................. <br /> ................ ----------- Rack Filled Yes ❑ No ❑ <br /> _ Water Table Depth Rock Size <br /> Distance to nearest: Weil........•...........:.. ...............:Foundation .................... Prop. Line .....-•--------•-•__-- <br /> V <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. <br /> Septic Tank (Specify Requirements) -------------- -- ..........•...... ...............................................-------------------•--------..._..•_.._....--••-----•--..'r <br /> 1 <br /> is osal ield (Specify Requirements) -_ ----.� ... . . ........� __.. <br /> ._ I <br /> - ._ .......... . .. ..... n._...._._._....._. _f'_.e^. ' ' . <br /> ra xisting and required addition on reverse side) <br /> I hereby certifythat 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 District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that inthe performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workm n's Compensation laws of California." <br /> Signed <br /> .................. Owner <br /> By ...........:.........:.. .. . ` '� Title _........ ....... <br /> ....... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED By .. . ........ ....... DATE <br /> --------------------------------------------------•--•=----_-----•----•----------:................----..•DATE . ----------...-:...----•-••--•----••..... <br /> BUILDING PERMIT ISSUED . <br /> ADDITIONAL COMMENTS ............... ................................................. <br /> ............ <br /> ..........................................-....._......._--•..._._.. F----------------------------------------........................ --•-•-------•--- -----•--- --•-----•----.-_.._---- <br /> ..........................:.......•---• .�!...:_:....: <br /> •--- ............................................. <br /> Final inspection by: _.. � rt -------------•-::_.............................................:........Date : x�. . ��............... <br /> SAN .IOAQUIN` LOCAL HEALTH DISTRICT <br /> E. 1q.13:Z4 1-'6'8 Rev. 5M 7/77 3 .i <br />