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FOR OFFICE USE: ? <br /> APPLICATION FOR SANITATION, PERMIT r <br /> ---------------------------------------------------- Permit No. --Of-7-7f, <br /> (Complete in Triplicate) <br /> ------------------------------------------------------ This Permit Expires 1 Year From Date Issued <br /> Date Issued -------- <br /> �47 <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 /> I !QENSUS TRACT - ------------------ <br /> JOB ADDRESS/LOCATION ._1-49__4'7._;?----- <br /> Owner's Name .-----J4,---A ------------------Phone ------------------------------ <br /> Address ------�a-/7--&°-------------------- City ---'Wzr - ----•------------ -------- ............ <br /> installation will serve: Residence gp-A—pbrtment House f] Commercial ❑Trailer Court ,❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:_______ Number of bedrooms ---0 ____Garbage Grinder _1yG--- Lot Size 19. i__CAV ______________ <br /> Water Supply: Public System and name ---------------------- ------------•--------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam I$ Clay Loam <br /> Hardpan ❑ Adobe '❑ Fill Material ------------ 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: (No septic tankorseepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK <br /> Size __ _ _____________ Liquid Depth __ ___ <br /> p --------------- <br /> PACKAGE <br /> No. Compartments _._Z--4_____________ <br /> Distance to nearest: Well ___ __ r <br /> r _ Foundation __-�- _-� p. -----____-- <br /> ��------------------ ----- � ---------- pro Line _ s <br /> LEACHING LINE ' No. of Lines -----/_________.____ Length of each line._�'�___-------_------ Total Length _ __ '..._._..........__ <br /> -'D' Box - <br /> -.,Q� - _ Type Filter Material Depth Filter Material ________________________________ <br /> r <br /> Distance to n-arest: Well __?0--- ---------- Foundation <br /> ------------------------ Property Line -------------------:.:7- <br /> "o <br /> PIT mf Depth _ ______________ Diameter 0 <br /> � �� ����� Number _______�_______________ Rock Filled Yes � No <br /> Water Table Depth ---&-,---------------------------------------Rock Size --/-'A---------------------- <br /> .Distance <br /> -------------•-------wDistance to nearest: Well ___ �� ---------------------Foundation _70---__.-___ Prop. Line ..... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date __________________________________) <br /> Septic Tank (Specify Requirements) ----------------------------------------------------------------------------------------------------------------.--------------------------- <br /> Disposal Field (Specify Requirements) -------------------- ---------------------------------------------------------------------------------------------------------------- <br /> I <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------•-•------------ <br /> ------------ - -- ---- - -- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) r <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, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ---------------------- - ----- Owner <br /> ------------------------------ ,,,,,,"" <br /> BY title . I�lrYl, <br /> ---- ------------------------------------ <br /> [If othe an owner} <br /> FOR DEPARTMENT USE ONLY, <br /> APPLICATION ACCEPTED BY ..--------------------------------------- <br /> Y ----------------------------------------- DATE ---Q� f r(a 9--------------- <br /> BUILDING PERMIT ISSUED ---------------------------------------- '- DATE _ . ----------------------------- <br /> ------------------ <br /> ADDITIONALCOMMENTS ----------------------------------------- -------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ <br /> - -------------- ------------------------------------------------------------ -----------------------------1,-- -- <br /> -------------------- ------------------------------------------------------------------------ <br /> ----- ------- =------- - ------- - ------- ----------- - ------ <br /> Final Inspection by: ------------------------------- -- --------------------- ---Date -- - - --- <br /> 9 <br /> SAN JOAQU ' LOG HEAL H IS CT <br /> E. H. 9 1-'68 Rev. 5M <br />