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FOR OFFICE USE. " <br /> APPLICATION FOR SANITATION PERMIT <br /> ............................................... 7.S.. <br /> .- ...--- Permit No. --.............. <br /> ..... <br /> r (Complete In Triplicate) <br /> ... -........,_.......-.-. $-,,{7S. <br /> Thls ParmItExpires I Year From Date Issued Date Issued .................... <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. 544 and existing Rules and Regulationst <br /> JOB ADDRESS/LOCATION ... /�.. ..., ,r .�..: - `�-..L-).............CENSUS TRACT . ........................ <br /> Owner's Name ............e <br /> O.. .LTij.....�? <br /> ................Phone ......... :......................... ..... <br /> Address .. ........ C. <br /> S. 33 <br /> Contractor's Name -/ ,=;�s� ✓ •----------------------------_- --.._.License #p. 6 -------- <br /> Installation will <br /> hone -----.-Installationwiil serve:——ResidenceX[r] <br /> Apartment-House-f] Commercial-OTrailer'Court-E] `� t <br /> MotOther -------------------------------------------- <br /> . <br /> Number of living units:_.____.__ Number of bedrooms ;......Garbage Grinder ____ ------- Lot Size __ .____. ............ <br /> - t'; -•--, <br /> Water Supply: Public System and name --_. - .............. ...........Private <br /> Character of soil to a depth of 3 feet: . Sand r] Silt 0 Clay' :[]-.,�Peat.O Sandy Loam Clay Loom ❑ <br /> Hardpan 0 Adobe 0 Fill Mpterial_:::.... 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 /> NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 20fl feet,) <br /> r . i -/ <br /> PACKAGE TREATMENT ( ] SEPTIC TANK[ I Size... --- Liquid"Depth _.. 4�/::............. <br /> Capacity ffi ..-. Typek,//o 5.PMaterial No.,.Compurtme-nts .,,-v. <br /> Distance to nearest: Well --- ref---------------------Foundatio` f 0_11.......... Prop. Lined-----.... <br /> LEACHING LINE [ ) No, of Lines ---:3------------ --- Length of each line---- ..--•........./Total Length <br /> ................ . <br /> ! E / n 1 .D' Box ._.-�.•_-- Type Filter Material .<. _-- ,,.- epth Filter Material -___-�� ........................... <br /> Distance tar ea.rest: Well ............... Foundation ...................\.... Property Line --......'-.......... <br /> SEEPAGE PIT [ ) Depth .......... Diameter -------- ------- Number .................�.,,..�. Rock Filled Yes C No 0 <br /> Water-Table'•De th-Y—:.- Rock Size:: ��-...- <br /> _-�-- - -------------------------------------•- <br /> E Distance to nearest.',Z11 ----------------------------------------Fovndation ......__...,_.....__ Prop. Line ------4___............ <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ------•------------------------------------ 0'0'a ___... �_------.._ .�..._--- )� r <br /> I Septic Ta%ik-(Specify'Requirementsl�-:-r ..................::: /' -- I <br /> t 3 <br /> Disposal#!Field (Specify Requirementsl` = ------------- --`--------------------------------------- '"+" f .................... <br /> s <br /> i I � . <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify I aif;t'have.prepared this application and that the work will be done in accordance with Son Joaquin <br /> { County Ordinances, St6te 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' orrnance of the work for which this permit is issued, I shall not employ aryl person in such manner <br /> as to becoreee sula)ec ma Compe satian laws of California. <br /> Signed ...._ 'p ` -------• -•-----•- ------------ <br /> By .... <br /> ------•--- Owner <br /> BY ...- --------- --- ----------------- -----------------------------------•----------- Title ------------ ...-.-........ : <br /> Of other than owner) I <br /> s FOR .DEPARTMENT USE ONLY <br /> ,APPLICATION ACCEPTED BY -'- _"_ - '... ." r <br /> -- ----_-----. DATE ...._ ...---' <br /> 'BUILDING PERMIT ISSUED '�__ _.\ . <br /> ---- .._.-DATE.-'•---- .......- <br /> ADDITIONAL-COMMENTS- ---------------- W. __r -.� <br /> ----------------------------------------------........................................................ <br /> ..---.._..--•---------------•--- <br /> a <br /> 1r ---••----'._. -- - ... - . -.........•..................................I............................. ------ ---------- ..._.. <br /> Final inspection �y: ............._- -•' Date _ _ -- <br /> ............. ............- <br /> M IM 13 2h 1-613 Rev. ' SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3m <br />