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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> �.... ................................_ ._ Permit No. . ... .............. <br /> (Complete.in Triplicate} <br /> This Permit Expires 1 Year From Date Issued Date Issued .- . <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heirein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ' <br /> f <br /> .a <br /> JOB ADDRESS/LOCATION �l .._. ....�' ���. CENSUS TRACT ' <br /> Owner's Name ...•..L1...... ' .f% ............ ............ .......:.................................. Phone ....... ..............• I <br /> k� Address ��'., ._.._.� �,......... ..................... .­.............. City ....................................-... _ <br /> Contractor's Name ....14-.1: 1. /4�s��_.. .._.License #c;ZP6.'6.aP-. Phone a <br /> installation will serve: Residence 1%Apartment House 13 Commercial Moller Court 0 � <br /> Motel Q Other............................................. <br /> Number of living units------ Number of bedrooms _......Garbage Grinder ............ Lot Size ...... ....:......................... <br /> Water Supply: Public System and name ------------------------------------------------ ..............................................................Prtvate1v <br /> Character of soitto-a de0th of 3 fee Sand El. Silt 0 Clay ❑ Peat Q Sandy Loam 1' Clay loan+ Q � <br /> Hardpan -Adobe Fill Material ............ If yes,type............:.. ............ } <br /> 4 <br /> (Plot {plan, showing size of lot, location of system 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 TANKS ] `. S€xe..�._..1�..�.1 'cry . a............. Liquid Depth ........................ <br /> ¢ Capacity .1s._ Type -_-.._. Material---.._---- _--_ No., Compartments <br /> .._. .............. i <br /> Distance.to nearest: Wei 1 ;' ._ �__.-_--__..Foundat€on _.� _..___...._. Prop. Line ... ?6.......... ti <br /> -- <br /> ' ..... Length of each line--_ ... .... Total Length �-�-v......... 0 . <br /> ©' Box 1•--- Type Filter Material /0Y�gADepth .Filter Material . .�. <br /> Distance to nearest; Well ........... Foundation __/.CJ--.............. Property Line '.. .............. Nit <br /> SEEPAGE PIT { ( Depth Diameter Number Rock Filled Yes ❑ No-C) :, <br /> Water Table Depth -----_-------------_ _--- = :_::hock Size .................... ..... i �'.4 <br /> a ,. <br /> Distance to nearest: Well <br /> ...........................::...--�-�-Fourtdatian .:.........:........ Prop. Line ...................... <br /> #� i <br /> REPAIR/ADDITION(Prev. Sanitation Permit ` rti _ Date ...................I <br /> Septic Tank (Specify Requirements) ...:._... ....... _.. ........ f <br /> Dis o . <br /> p ;sal Field (Specify Req.uirernents} .__ y .�F - .._ .1 .__ .___ ...................................r� ....... <br /> # , . <br /> ........... .........•-------------------------------- ---- -•--•-............---•......... •-- .-f r-� .........----• ;• ....................................................€ ._IN.............................� .............. � <br /> (Draw existing and required addition on reverse-side)' <br /> I4 hereby certify that 1 have prepared this application and th at the�work ,will be.done.in-accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of fhe'-San-Joaquln Local Health?District. Horne owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the p rformance of the work for which this permit is4ssiied,-1 shall--suet-employ-any person in such manner <br /> as g to become sub ec o �cma om e�nsation laws of Calif°it►Own <br /> 1 �" <br /> Sighed ned ___.. r <br /> -1----... - er <br /> BY - ------- --• ------------- ► Title - - _ _ _ . ------ <br /> _______________________________________..__......._._____ ...____,..____..__ .... .. J <br /> r —(Il other than�wnerl. _-T_ .. _„�-�.._- - -- . _.._..T . ._ � ,..� <br /> WR DEP RTMENT''►ISE"ONLY x # <br /> APPLICATION ACCEPTED BY --- --- - ------------ ---- --------•------ -----• DATE._._,. T- .. <br /> BUILDING HERMIT ISSUED -- ----- • --•-- ----------- --- <br /> DATE <br /> .. .............. <br /> ADDITIONALCOMMENTS -------------------------------------------------------------•--•-�-•-------...---.._..._I----------------- ..._-.-.. •-------------------- ................ <br /> --------------•---------•- ._........... <br /> .....----------------------------------- - _-------• ----------------------_.-._....-----..------.--.__-_..--------------------------------. <br /> -------------------------_..-----------•---•-•..._....... . 7-.... _._._....._...-- _ .. ....... <br /> ...--------------- ........__...- -------.... 7 <br /> final Inspection by: .......................... --------------- ---- __................Date .... . �_./..EH . <br /> 13 2kr 1-68 Rev. 5MSAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />