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FOR OFFICE USE. <br /> Ik-7 APPLICATION FOR SANITATION PERMIT <br /> ................... ................ <br /> .................. <br /> ..................... ................... . lComplete.In Triplicate) Permit No. <br /> ................ This Permit Expires 1 Y <br /> .......... ear From Date Issued Dote Issued 700 C. <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application Is made In compliance with County Ordinan€e o. 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LOCATIQL�_.C.e_,..� ...................:.CENSUS TRACT ................. <br /> Owner's Name . ..... <br /> Address ....... <br /> ........... . . <br /> . ..... ............. Ci ty . . ...... <br /> 'Contractor's Nomej 7 <br /> Vphone00 <br /> Installation will serve: Residence J'a"Apartment Housed Commercial ]Trailer Court 0 <br /> MotelE]Other.................... ....................... <br /> Number of living units:_.- _._ Number of beroomsGarbage Grin*r ot size <br /> 'Dom ------ <br /> Water Supply: Public System and name _ - ---------PLAS <br /> r-4. .)_ _----------------Privateb <br /> Character of soil to a depth of 3 feet. Sand 0 Silt.0 Clay Peat❑ Sandy Loam 0 Clay Loam 0 <br /> Hardpan[J Adobe.: Fill Material ------------ If yes,type................ ............ <br /> (plot plan, showing size of lot, location of system in relation� to wells, bu"ildings, etc. must be placed on reverse-,side.) <br /> NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer is available within 200 feetJ <br /> PACKAGE TREATMENT SEPTIC TANK Size:. Liquid Depth ---6.............. <br /> S. 7— ----------- <br /> Capacitylvor 1P ly 70&e" <br /> pe Material---1� Compartments ..17 ... ........... <br /> M <br /> Distance to nearest: Well A!,__A/A..........Foundation ...... Prop. Line b1___e-------- <br /> in <br /> or e ch <br /> LEACHING LINE IV No. of Lines _- -•--/------------ Length of e ch 11 e. --- Total Length ............ <br /> V Box:�__e------ Type Filter Material Y­ _.. ...Depth Filter Material ............. ................. <br /> V . _ . Foundation <br /> Distance to nearest: Well )V-_ . � - .. Foundation ....... Property Lln947................. <br /> r�7_4---ee <br /> SEEPAGE PIT Depth a4_74r------ Diameter .?3"Number ...... ............... Rock Filled Yes No 0 <br /> Water Table Depth --- ....... <br /> _q <br /> ---Rock Size .. ..................... <br /> Distance to nearest: Well ---- ---- ............. .... ..Foundation /*r_/I...... Prop. Line s5 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ................. ............ <br /> Septic Tank (Specify Requirements) ........ ............ ...... ...............••----•----•--•. ............. .....................I........................ ......... <br /> Disposal Field (Specify Requirements) -----•.........-•--••--•----------------------••----- --------------------- ------- .............. ....... <br /> - <br /> -----------------------------------------------------------------------------------------I-----------------**"-,-*-----------------------------------*------------------------------*..................... <br /> ---------------- ------------ -------------------------- --------------------------------------------------------------------------------I..................... <br /> (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 Son JoaqiAn <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 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 /> Signed •;�. ......... ........... _ ------------_---- .... Owner <br /> By ...... . .. .... .......... <br /> --------- Title <br /> Ili outer than owner <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..--- --- - ­ ---- -- ------ -- -------- ---------- ------ DATE --------------- <br /> ./0- --- ------------ <br /> BUILDING PERMIT ISSUED ...... .... ... ------ <br /> ..... .... .. <br /> ----- -- . ....... <br /> --- - ----------- - --- -------- ------ -- ------- --------- <br /> ADDITIONAL COMMENTS 4..........X------- <br /> 4� <br /> 9 <br /> ... . . ................................... .................................... --­----------- ....... ------------­ <br /> ---------- ------------------------- ------------------•• • ...... ......... ............ ------­............. ......... ................... ..................... <br /> --- ---- - - ------- ----- --- -- ----- <br /> FinaI'Ins_p_e_ction_by:'_._._�...... --------------------------------------------------------------------------- ------------------- ...... <br /> - ----------------------___--------------------------- ----------------------.-.Date ...... .7, <br /> EH 13 24 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 311----------- <br />