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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> -------------- Permit No. 7Z... Z <br /> (Complete in Triplicate) <br /> ----------- <br /> This Permit Ex fires 1 Year From Date Issued Date Issued 4,.X <br /> --------------------------------------------------------- P <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 /> y� --------------------------------------CENSUS TRACT --------------•---------- <br /> JOB ADDRESS/LOCA/TION ....... 7_-�`_1 --.-- -- --- /�-_-_------- S <br /> Owner's Name --- F� /✓D�ll� 'i>f� 1�1_�l•�9 �U�---------------------- ------- ------._Phone � Y:. 71-5-V.--•- <br /> Address .'lr� �_. -------------------------------------------- <br /> 17---------------------------------------------------- City ------S�ej�'fd/ <br /> f------------- ------------------------------_.-.License # -----------------------. Phone ----------------------- <br /> Contractor's Name ----------------------------_---- ------- <br /> Installation will serve: Residence ®Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other -------------- ---------------------------- <br /> Lot Size .-_� �` ��-� <br /> Number of living units:__.. Number of bedrooms _-�.-_-_Garbage Grinder <br /> I____p___ - _----------�------'�j"�'( • <br /> Water Supply: Public System and-name -------------------- -•-_----------------------------'- t'.P! ---------------------------------Private [ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ <br /> Hardpan ❑ Adobe' Fill Material ----___---- If yes,type -.-.-_-------------------- rr�-- <br /> • - W <br /> (Plot plan, showing size of lot, location of system in relat on_to wells, buildings, 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 [ ] SEPTIC TANK [ ] Size__--------------------- --------------------- Liquid Depth -_---_.-.__-__.-..------ <br /> Capacity ------------------- Type -------------------- Material----------------- " No. Compartments .------------------_- <br /> Distance to nearest: Well ._..___ ---. _-- --------- ---Foundation ---------------- -.- Prop Line. ................. <br /> LEACHING LINE No. of Lines ---------- ------------ Length of each line----------140 ___ Total Length ---W -- ------------- <br /> `D' Box ---""�--- Type Filter Material /_ __-_Depth Filter Material ------_ - <br /> Distance to nearest: Well ---- _--------- Foundation -------/_. ............ Property Line -.-., ...--_-_-- <br /> S`" __.- Rock Filled Yes No <br /> SEEPAG Depth -----� �_-- Qitmreter ���/-��Number ___________�--_----- � � - <br /> Water Table Depth -------- <br /> l - Rock Size <br /> Distance to nearest: Well -------- - �------------------Foundation ---AA <br /> --- Prop. Line --.---.J .-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------. ------------------------------------ Date _-------_---_----..--.---.------) <br /> SepticTank (Specify Requirements) -------------------- --------------------------------------------------------------- -------------------------------------------- ------------ <br /> Disposal Field (Specify Requirements) ----------- <br /> --------------- �-1 <br /> -------------- ------- ----- <br /> --- ----- ----- - - ---- ��--- - �-------- -,� <br /> ---------------------- -------------------------------------------------- ----------- -------------_------------------------------------------------------------------ <br /> (Draw existing <br /> 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 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 /> "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to becco a subject to Workman's Compensation laws of California." <br /> Signed`'1 ------�--- V_ _11-- -- -------------­--- Owner <br /> By ----------------------------------------------------------------------------------------------------- Title ------------------------------------------------------------------------ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -----------�----------------------------------------------------------- ------ -------------- DATE 141,--2------------------- <br /> BUILDING PERMIT ISSUED -- -- ---- - DATE <br /> ADDITIONAL COMMENTS ._3.__�2 __ �_ .__ _G� _ -`!- n _--- _ """ " ' <br /> ---------------------------- <br /> -------- -------- ,�- ` ,� <br /> ----------- ---------------------------------------------------------------------------------- -------------------------------------------------------------------------------- ------------- ----------- <br /> �r� --------------- <br /> FinalInspection by; ------- ----C.O__"---------------•------------------------------•---------------- --------- Date --------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />