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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. ----------- <br /> (Complete in Triplicate) <br /> � -- ------- -------------------------- ------- 3- 7-�3 <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 permit to construct and install the work herein <br /> des"cribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> t - . <br />► JOB ADDRESS/LOCATION M a d 6- _ CENSUS TRACT ._-- .---- <br /> Owner's Name 2 T ftJ-------------- Phone <br /> -------------------------•---•-•----------------------- -------- <br /> Address -- ._3_0----W`---UA-1P-i-44-0-------------------------------- ------ City_rPl9 -L -------------------------------------------------------- <br /> Contractor's Name -.60, Zce � ----.— - --------------------------- -------- ' <br /> Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court <br /> Motel F1 Other---- ---------------------------------- <br /> Number of living units:_____(_____ Number of Bedrooms ----- <br /> Garbage Grinder ------------ Lot Size -------------------------------------------- <br /> I <br /> Water Supply: Public System and name --------------------------------- -- - - ----- ---------------------------------------•--•---- <br /> _-Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ ClayµM Peat❑ Sandy Loam M Clay Loam :❑ <br /> Hardpan ❑ AdobeE] Fill Material --77—If yes, type __ _ _______________________ <br /> (Plot plan, showingsize 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 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK' Size____ ` ___ _ /_Q-_ . _ <br /> { 7 [ l --- - - - - -- - - Liquid Depth ._r3�................ <br /> Capacity Ve0_6------ Type aint7Material No. Compartments _____ <br /> Distance to nearest: Well ____ _r----------------------Foundation ---/__D_1--------- Prop. Line <br />' LEACHING LINE [ ] No. of Lines ._________________ Length of each line-20__ <br /> Total Length . 7.-6----------------- <br /> 'D' Box ___I__._-__ Type Filter Material f �-_-_.•Depth Filter Material ZF ---------------------------- <br /> Distance <br /> __________ _ __Distance to nearest: Well .....9--D?_--___-_- Foundation ...._________ Property Line. -5_-_________________ <br /> SEEPAGE PIT [ ] Depth -------- ------------ Diameter ---------------- Number -------------.------.------- Rock Filled Yes ❑ No <br /> Water Table Depth ---- -------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ____________________-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) _ <br /> ts} ------ -------- I <br /> Disposal Field (Specify Requirements) ---------•---------•------------------------------------------------------------------------- <br /> --------------- •--------------- <br /> ----------------------------------------------------- - ----------------------------------------------------------------------------------------------w- ---------------------- <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 i <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 Workman's Compensation laws of California." <br /> Signed ---- --------------------------------- Owner <br /> BYA ------ ------- Title ------------------------------- <br /> ---------------------------------------- <br /> (If other than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY ------- ------------------------------------------------------------------------------ - ---------- DATE -- ---------------------------------------- <br /> BUILDINGPERMIT ISSUED ------------#------------- ------------------------------------------------------------------------DATE ------------------------------------------ <br /> ADDITIONALCOMMENTS ------------- ------------------------------------------------------- --- --- -------------------------------------------------------------- ------- <br /> ------------------------------------------- <br /> . <br /> ---------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------- -------------------- --------- ------------------------------------------------------------- <br /> -----------r_�_LP�Al_ <br /> - - ------ --- -----Final Ins ection bDate ___SAN JOAQUI HEALT <br /> E. H. 9 1-'68 Rev. 5M C <br />