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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No>7 <br /> ------- ------------------------------------------------ -_ <br /> (Complete in Triplicate) <br /> --------I---------------------------------------------- <br /> Date Issued 5:�---�7/ , <br /> ----------------- - -------------------------- This Permit Expires I Year From bate Issued <br /> Application 1s 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 /> JOB ADDRESS/LOC N .%Dat7�7 . e/]- zt �C. - - --------------------CENSUS TRACT -------------------------- <br /> Owner's Name - - -- ----------- -- -------------- ---- -,---- <br /> � r nse ---- -------Phone ----- <br /> ----------------------• -------- <br /> ----------- ---------- <br /> Address ------------ <br /> Jt ---------------------- -- ---------1-.. ty ---------! - <br /> # �� -J Phone Contractor's Name ---- _ -- ---- ------------ <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial []Trailer Court ;❑ <br /> Motel ❑ Other <br /> + Number of living units:__-___ __-. Number of bedrooms __ -..Garbage'Grinder ------------- Lot Size ----Ci--��•- --may --------- <br /> WaterWater <br /> Supply: Public System and name -------------------------------- -------------- ------ ------------------••-•-----------------------•---------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ {t❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 'E] <br /> Hardpan e Adobe ❑ Fill Material ------------ If yes,type ---------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.{ \ <br /> seepage pit permitted if public sewer is available within 200 feet,) O <br /> NEW INSTALLATION: (No septic tank or <br /> PACKAGE TREATMENT { ] [� r/ <br /> SEPTIC TANK' Size- -- --= = ---X`�--------------- Liquid Depth --Y--------------------- <br /> Capacity0_p- Type --- Material---f` } � No. Compartments __ ---------.---- <br /> Distance to nearest: Well ----------r�'n�............. _Foundation -----/-V........... Prop. Line ----_-:-------- <br /> LEACHING LINE [►� No. of Lines ----- j---------------- Length of each-:line--..--- -_-.......... Total Length ,_I_�_�_f <br /> `D' Box ------ Type Filter Material ---_ - -'-`__.Depth Filter Material ------ - ---------------------------------- <br /> Distance to nearest: Well _. �______________ Foundation ___._ �____________ Property Line .__.________ ___________ <br /> i <br /> SEEPAGE PIT [ Depth --.-a- r---- Diameter ��3_f----_ Number ------------------ Rock Filled Yes No i❑ 1 <br /> Water Table Depth --------------- --------------.--------Rock Size --Cl2____ ------------ <br /> Distance to nearest: Wel! ---------- -----------------Foundation ----10_---_----- Prop. Line -S--------........ <br /> REPAIR/ADDITION{Prev. Sanitation Permit* ----------------------------=--------------- Date -------------------------------_--) <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------:----------------. --------------------------- <br /> Disposal Field (Specify Requirements) -------------------t ----------------------------------------------------------------------------------------------------------- <br /> y � <br /> ------------------------------•-----------------------_-----•---•----------------------------- -- --------- 4-------------------------------------------------------------------`---------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application dnd;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 permitis 'issued, I shall not employ any person in such manner <br /> as to become subject to Workman's CompensatLon laws of California." <br /> . V <br /> -- <br /> Owner Signed ------------------ --- <br /> - � r <br /> J----------------------------------BY ---- -- <br /> (If other than owner) <br /> k _F DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----N----------------------------------------------.---------- DATE __ - -•------------------- <br /> BUILDING PERMIT ISSUED ----- `" - = DATE ---------------- <br /> -- ------ <br /> ADDITIONAL <br /> ----ADDITIONAL COMMENTS -------------------------- ---- ..---------------------------------------------------------------=--------------------------- <br /> - <br /> ---------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ <br /> ------ --------- <br /> = --------------------------------------------------------------------------------------- <br /> ---------------- ---------------------------------------- --------- ---- - - -- - <br /> ----------------------------- - <br /> Final Inspection by: -- __Date - -------------------- <br /> - -----_ -- - <br /> SAN JOAQUIN LOCAL HEALTH -DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />