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4 ( <br /> FOR OFFICE USE: APPLICATION 'FOR SANITATION PERMIT <br /> ------------ ---------- -----l------- ------------------ <br /> Permit No: ._7. <br /> 11 (Complete in Triplicate) T.11:11 <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 per 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/LOCATION . ----- ------- �--------- ----------------- CENSUS TRACT <br /> Owner's Name _ 5u.k2- ----------Phone ------------------------------------ <br /> Address =[ --------- - - -=----------------------------------- City ��-�'��a <br /> -#� <br /> Contractor's Name `�° ��a-- - License # _ - .. Phone --- s=_ <br /> Installation will serve: Residence partment House-E] Commercial �❑Trailer Court ',❑ ,� <br /> Motel ❑Other -------'------------------------------------ ' <br /> Number of living units:-------- Number of bedrooms �j____`-`Gcrrt=ge-Grinder }__, Lot Size -�-19 �`� <br /> ------------------------------- <br /> I } -- - --.------`fg-F -------------------- <br /> Water Supply: Public System and name ----------------------------- --_----------- --------Private [Z}� <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ .-!Clay ❑ Peat ❑ Sandy Loam —Cl-ay Loam:❑ I <br /> ' Hardpan [J Adobe'] Fill Matefial_____________ If yes,type --_______.___________-__-__ <br /> (Plot plan, showing size of lot, location of system in relation to welle,-buildings, ;etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is al;ilable within 200 feet,) i W <br /> f Y <br /> PACKAGE TREATMENT [ ] SEPTIC TANKSize-------YX�'� �------ ` \I <br /> ------------ Liquid Depth __'�1�-------------- �. <br /> Capacity .... - --- Type - -�c s_ Material_atu&_n_P- - No. Compartments __ <br /> l , - ________________ <br /> el � �o <br /> Distance to nearest: rik7 _- <br /> Prop. Line _. ........... <br /> LEACH LINE f]�I No. of Lines ___ ____ ____________--Ldngth of each'I�ine___�U�_ ��_i 0_____- Total Len th _XQ <br /> ........ <br /> -------- <br /> D' Box -,!?-,____ Type Filter Material _ - ___Depth Filter Material ___ _ _________________________....___- <br /> Distance to nearest: Well ___��_______/--- Foundation ___________ Property Line .6-------------------- <br /> SEEPAGE PET; [ } Depth -------------------- Diameter ''f________.Number ._____..___________________ Rock Filled Yes E) No 0 <br /> Water Table Depth <br /> - ------------------------------------Rock Size -------------------=------------ <br /> Distance to nearest: Well -------- ----"---------------------Foundation -------------------- Prop. Line ...................... <br /> I v � <br /> REPAIR/ADDITION(Prey: Sanitation Permit# ------__.----------------------------------- Date __________________________________) <br /> i Septic Tank (Specify Requirements) ---- -------------------------------- ------------------------------------------------------ ---------------- --- ----------------------- <br /> i ---------- ----- <br /> .i� Requirements) -----------------------------------`--------= - -- --------------------- <br />� Disposal Field (Specify R � <br /> �,._..�-��- -.__ y. F _ ___________________ <br /> ______________________--------------------------------------_- -______________.__ -___-_--___________________._11 1+_____._._ , ____--______________.__________________�_'________k--4 tri./ <br /> jj <br /> 1 i (Draw existing and required addition'on reverse side) ' # <br /> I hereby cert1ify that I have'prepared this application and that the work`will'be done in accordance with,son <br /> .loaquln <br /> County Ordinances; Statd-Eews, 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 /> I f , <br /> B I------- <br /> -------------- Owner . <br /> Signe <br /> Y - <br /> W---------------------------------------- Title <br /> � (If other tha ow er) <br /> . FO DE RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ - �- ---- DATE ,`�'�` ~'- ---------------- <br /> ---- -------- --- - ----------------------------- <br /> BUILDING PERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE -------------------------------------- <br /> ADDITIONAOCOMMENTS ----------------------------------------t------------- ---------------------------------------------------------------------------- --------------------------- <br /> -- <br /> , <br /> -------------------- ------ �' <br /> l ------ <br /> ---------------------- - ------------------- ---- ---- - ---- - -- <br /> Final Inspection by: ------------- -- . --- -----------------------------------------------------------Date - -- ~-�r-��-��-- : --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 - 1-'68 Rev. 5M �s <br />