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1 c.1 <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> - <br /> ------------------I:------------- - ----- Permit No.. <br /> (Complete in Triplicate) <br /> - ---------------•------ ---------------------- <br /> ----------------------------------- This Permit Expires 1 Year From Date Issued Date 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 /> 11 1 <br /> JOB A DiDRESS/LOCATION -- :- - -----reP----------- ------- -CENSUS TRACT -------------- ------__ <br /> Owner s Name -------------- = Phone --..." <br /> I Pte- <br /> Address-.� J�Q �/IJ 3 City _ /Q <br /> Contractor's Name /�• 7�L1� ------------------ ' License # 5.` 1 Phone <br /> Installation will serve: Residence N Apartment House-[] Commercial ❑Trailer Court i❑ <br /> 1 Motel F-1Other -------------------------------------------- e G <br /> Number] of living units:___(_____-_ Number of bedrooms __7-___Garbage Grinder ------------ Lot Size __1____y_____________________________ <br /> Ij <br /> Water Su pply: Public System and name ---------------------------------••- -------------------------------------------------------------------------Private V <br /> JWN <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ri`' Clay Loam <br /> Hardpan ❑ Adobe'❑ Fill-MG—ter id'lIf yes,tip-e- <br /> --------------- <br /> (Plot <br /> ype ___-_____-__(plot pi n, showing size of lot, location of system in relation to wells,bOildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if publO sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size____ -X- ��X --------------- Liquid Depth ._257-5-r' _----_. <br /> ' Capacity} , ri <br /> _ __ -__ TYpe � �' MateaI�_____________________ No. Co.mp <br /> atments - <br /> � <br /> r <br /> ve <br /> Distance to nearest: Well __ ______________Foundatian/-_________-_ ___ Prop. Line -______. <br /> LEACHING LINE.. [ ] No. of Lines 73---------------- Length of each line___ Ur�____.._--_ Total Lenlz� <br /> Length ra _ <br /> D' Box ---r_______ Type Filter Material Z�CV��epth Filter Material -__-----..........-------_---- <br /> Distance <br /> .. ..._----Distance to nearest: Well 1 _ ______________ Foundations ___________.__ Property Line 4� -------------- <br /> 1 [� <br /> SEEPAGE PIT [ ] Depth ------------- Diameter ________________ _Numbe'r�-------------.--.____._____ Rock Filled Yes ❑ No C <br /> Water Table Depth -----------------------------------" Rock,Size --------------­-------- <br /> Distance <br /> •--------Distance to nearest: Well ____________________________________--_Fobn`ation -- _____.___.--_- Prop. Line. ....___--___.__--__._ <br /> -�# e <br /> REPAIR ADDITION(Prev.(Prey. Sanitation Permit# _______________ _______________ --- ---- 'D,ate�:'___._____......___._-________) r <br /> Septic Tank (Specify Requirement`s} -------------------------------------------------------- -----+--------------- ------ <br /> y <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------ ---•----------- <br /> SfI ------------------- --[-L-..---....-.---- ------------------------------------------ <br /> ------------ISA----------_-----------_---------_------- ---------------------------------------------_ _ ___ _-- -------- <br /> I a '(Draw existing and required addition on reverse-side) <br /> I hereby certify that I have prepar6cl 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 in the performance of-the work for which-this- issued,1-shall not employ any person in such manner <br /> as to become subject r&mans Compensation laws of California." <br /> Signed II. -. � <br /> r <br /> g ---- ---------- -- ---------------------------=----------------------------------- Owner iBy . <br /> II ------------`'------- ] ---- Title <br /> (If other than owner) <br /> t I t FO DEKA MENT USE ONLY <br /> k APPLICATION ACCEPTED BY -------------- - DATE J T 2 <br /> BUILDING PERMIT ISSUED -` " DATE ------------------------------------------- <br /> --- ------ = y <br /> �s !1 f . 5.¢ �.kti� <br /> ADDITIONAL COMMENTS -------- -- ----- --- --- ------- - -------=- <br /> ----------------------------------------------------------------------------------------------------------------------------- - <br /> -- _- _ _ ------------------------- <br /> -------------=-------------------------------------------------------------------------------------------------------------------=-------------------------------------------•--- <br /> At <br /> Final Inspection by; ---------------- Date -----/ _ ----- -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />