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FOR OFFICE USE: - <br /> APPLICATION FOR SANITATION PERMIT <br /> .. ........ ......................... Permit, . ........I............ <br /> (Complete in Triplicate( oY <br /> .............. ......:........:..•••......... :6- 7s <br /> s ........ This Permit Expires 1 Year Froin Date Issued date Issued ..................... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Insta erein <br /> described. This application is made in compliance with County Ordinance Na. 549 and existing Rules and Regulations: <br /> Jos ADD>�l ss/LOCATioN Jib ........_.. . ...................„.,,CENSUS.TRACT .................. <br /> _. - v 1 <br /> Owner's ame --_ <br /> ' l�_. r _G.._ f ...... ................... 933 <br /> ........... <br /> Address. -.._._,.. Clty ................... <br /> License #v� ..5-.�Z;4 one .............................. <br /> Contracto 's Name ....,�.� .. 4-- G L ........ -...._ -� <br /> Installation will serve: Residence VA.partment House Commercial QTrailer Court Q I <br /> Motel Q Other............._-----_-_--_-_------ <br /> Number if living units:'-----_• Number of bedrooms; ......Garbage Grinds ............ Lot Size . ..:.......................... <br /> Water Supply: Public System and name ......................... ..........Private <br /> w - <br /> Character of soil to a depth of 9 feet:. Sandt] „Silt❑ t~IayQ Peat QSandy Loam Clay Loam Q <br /> N." <br /> Hardpan Q Adobe Q Fill.Material ..... If yes type ............... ............ <br /> I } <br /> (Piot plan; showing size of lot, location of system in relation to wells, buiings, 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 j ]] SEPTIC TANK 1 ] Size__............. .............. Liquid Depth .................... <br /> Capacity -------------------- Type -------------------- Material...................___ No. Compartments .....................0 <br /> I <br /> Distance. to nearest: Well ------------------------------------Foundation .._.-_--. ... Prop. Line ..........._........ <br /> �� , <br /> f LEACHING LINE [ ] No. of Lines --------- ...... length of each line........... ...ti.. Total Length ............................ <br /> UA <br /> e--F' er- aterial .....Depth Eiffel: Material •------• <br /> �Jistance to nearest: Well :.. _: .._ Foundation ............ ; --..)�roperty Line ...................... <br /> _:_...' .: Rock filled Yes No <br /> SEEPAGE SIT t De thug, A ------.---- Diame ..... ......... Number ........ ❑ ; <br /> [ ]. p ter <br /> Wate' fit......-• ----- - ------ -----•--•--•---.Rock Size . ....... ............. .... <br /> i <br /> e Depth <br /> Dista nearestitwell ---- _•-- ----- ---------=------Foundations_ :.........:.,. Prop. Line <br /> REPAIR/A)DIVIN(Prev. SanitatiorrPermit# ..-' <br /> ... Date !. --•------ -I <br /> SepticTank S ecify q ' _ .......• .......................................:..---•-•--....._.................._.........--•---=•-•--.... <br /> C.�..a �- <br /> Disposdl Fie('d (Speee- ' q ire cents), t-- �• C� i•-fL.. -------)................................... <br /> ---- -----.---------- •-. <br /> - .-- :.............1__. ..................................................... <br /> ----- ----- � _ <br /> (Draw exi�ting.and re gdired addition on reverse side) <br /> 1 hereby Eerti than h e irepgred}this4.app ication and that the work will be done in accordance with .San Joaquin <br /> County Oidinances, Stat ays,i ad Rfes and Reguldtions of the San Joaquin Local Health:District. Home owner or litan- <br /> r sed agents signIatufre,.rert i` s the fallowing; <br /> "I tertify ghat in the - rmance of the work for whirl this permit Is"Issued, I: shall not employ any person In such manner <br /> as to become s�ub1ec�o Workman's Compensationt laws of California. <br /> Signed -----------------------•- .. ---- Owner <br /> w <br /> BY -------------------•------ ....:_ -------------------- -----•--•- ------ , itle -- -----------.------ ------------ ................ <br /> (lf other than owner) 7 <br /> FOR DEPAAA NT USg0NCY <br /> APPLICATION ACCEPTED BY- •--- <br /> . -------------•--...__.._._,....---........_.....-......._...------•-------................-.-_DATE -- -------------------_ ------ -------- <br /> ADDITIONALCOMMENTS ----------------------------------------------------- ----------•----••-----------------....._ ------------------- ..................... -----••-------- <br /> 4 -•-•------------------•-----------...__._..._-..-•----•-------------------•-•-- ._.--••----------- ------- ---------------------------------- ............... <br /> •------------ -------------- ....................................---------------------- -------•-................-.......................................... <br /> ... <br /> .. <br /> Final Inspection by- ------------- --•---•-•---.....----._.._.._........_•---_.....Date ....... ......... <br /> EH 13 .24 1.-68 i;ev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />