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FOR OFFICE USE: <br /> APPLICATION FOR. SANITATION PERMIT 7S <br /> -------------------- -----=----------------- Permit No. <br /> (Complete in Triplicate) <br /> ------------I-------------------------------- <br /> ------------------_---.------.- - --- ---_- .____ This Permit Expires 1 Year From Date Issued Date Issued _� _ --7____ <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 comp-Mance with Co nt Ordi nce No. 549 and existing Rules and Reg lations: <br /> JOB ADDRESS/LOCATION ------ --- -'--�-----.- .CENSUS TRACT --------------------- ._.. <br /> vwoo <br /> Owner's Name .--- OM----- )�`/V J +► _ -------- --------------------------- ----------- -- ------Phone d--_3-+--/--15------------ <br /> Address -------- ---------------:X__1----------------------------------- cityy -------------------------------------------- <br /> Contractor's Name ------ =-A,. ----- ------.License #�r�3l.l�---- -Phone <br /> Installation will serve: Residence (`Apartment House-[:] Commercial:❑Trailer Court I❑ <br /> Motel ❑ Other -----r--�--------------------------------- <br /> Number of living units:---I------- Number of bedrooms -6.------Garbage Grinder -------------L Lot Size ---------------------------------.---_______ � <br /> Water Supply: Public System and name ---------------------------------•-- ---------------------------------------` - Private �. <br /> Character of soil to a depth of.3 feet: Sand'( Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ _ k:i <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- <br /> (Plot <br /> _______________________ _(Plot plan, showing size of lot, location of system in relation 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 fe et,)tt//� <br /> PACKAGE TREATMENT [ ] SEPTIC TANK;[ ] Size____ �_ ` _. _ Liquid Depth ? y-------------- <br /> Ca -------------- <br /> Capacity fCO >�� i iteriai_ No. Compartments __r'�` <br /> P Y ------------------- Type --- ------- p .......... 6 <br /> Distance to nearest: Well --------/_6-Q----------------Foundation __ _/0 Prop. Line,_ ..:........ <br /> J <br /> LEACHING LINE [ ] No. of Lines ---___ I <br /> _________________ Length of each line_--_��______._____-__ Total Length _� --U------------- <br /> 'D' Box ---1____ Type Filter Material 12 / __Depth Filter Material _f __________________________________ <br /> Distance to nearest: Well __1_P6------------ Foundation _!_P--------------- Property Line ---------------•--•-•--- O <br /> SEEPAGE PIT [ ] Depth ___________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes 0 No ❑ ID <br /> Water Table Depth ---------------------------------------- <br /> _____Rock Size _______________________________ Q' <br /> Distance to nearest: Well ----------------------------------------Foundation ---------------- ---- Prop. Line -------------- ....... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------- ----------------------------- Date ----------------------------------) <br /> SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------------- ----------------------------- <br /> DisposalField (Specify Requirements) --------------------------•---------------------------------------------------------------------------------------------------------- <br /> -------------------------------------- ----------------- -- ------------------- --------------- ------------------------------------------- ----------------------------------- <br /> (Draw existing 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 /> "I 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 become subject to Work an's Compensation laws of California." <br /> Signed -- -- ----- -- --- Owner <br /> BY - - ----- ----�'"= ` Title ----------------------- <br /> ------- ---------------------------------------- <br /> - other than owner) <br /> F RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY __.____ _ -- -------------------------- DATE ...�Z - __ ..5 ------- <br /> ----------------------------- -- ------------- ------------- <br /> BUILDING PERMIT ISSUED -------- _ - -- DATE t----------------------------------- <br /> ADDITIONAL COMMENTS -- ---- .� � .�c<-� - ---/:, ---- ---- s� � 1 <br /> -- --------- --------------------------------------------------------- ----------------------------------------------- ------------------ ------------------ -------------------------------------- <br /> -------------------------------- ---------------------------------------- <br /> Final Inspection by: -------------- - - --------- <br /> Dater------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />