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FOR OFFICE USE: <br /> r —APPk)CATION FOR SANITATION PERMIT <br />...... .....-s. �.�..C1............................. <br /> (Complete in Triplicate)" -- Permit No. <br /> This Permit Expires 1 Year From tato issued Date Issued .. E :.7 <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 /> JOB ADDRESS/LOCATION ._ ..�✓.. 51 6lay.....A.V_4.............. . ........... ... ....................CENSUS TRACT .......................... <br /> Owner's Nome .. 0.�.i. _.1'r.[s.4� .t'9! ........................ ........ .. ......Phone SAGS ! <br /> i <br /> Address ....... __......... ----....------...... -----------------I., City - S.To_CA..7`es,V...-----.._...------..--.................. <br /> Contractor's Name ..( �hc --- -------- ------------_-------.License # - - - - - ............-- Phone .......-...................... <br /> Installation will serve: Residence ❑ Apartment House f:) Commercial ❑Trailer Court <br /> Motel ❑Other <br /> Number of living units:.. ......... Number of bedrooms -._-.._Garbage Grinder ..... .... . Lot Size ... .�.F_._A. ..G.r.- $..-__------ <br /> Water Supply: Public System and name . .....................----•---•--_ --------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe 101 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 tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f;j SEPTIC TANK-[ ] Size........j?aC1____�/a f/d- /.... Liquid Depth ...... .................. <br /> Capacity .- Type ._........._... ..._ Material. ....... No. Compartments ...................... <br /> Distance to near : Well . .J(.j...................Foundation ..... ............-... Prop. Line ............. <br /> LEACHING LINE [ ] No. of Lines .. . ._.. Length of each line .-. $�L` -._... .... Total length .. . <br /> 'D' Box .• •- Type Filter Material --------------------Depth Filter Material _... •-................................. <br /> .._ Z <br /> Distance to nearest: Well ........................ Foundation . .- Property Line <br /> SEEPAGE PIT [ ) Depth T X S.X'.�flDiameter _SGA90Number ...._ stock Filled Yes -, No ❑ <br /> Water Table Depth --•--._................ .......---.....------..Rock Size . ..................... 6 <br /> Distance to nearest: Well ........................................Foundation --..--.-.... ....... Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ---------------....---------------) <br /> Septic Tank (Specify Requirements) ................... --------- -------------------------- ............................ ------ ....... --._._.......... <br /> Disposal Field (Specify Requirements) -------------------•- ---------------------------------- ---............ ...... .......•--............................ <br /> ------------- ------------------ - - - ­-... -.. . .. ---------- ------- ----------------------------- ........­ .... ...-.-..................................... C <br /> ----------- - -- ----- - .... ... ......---...... ..- ----------------------....-----... ........--............. ...----------.. ........ <br /> r <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. Nome 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 last me su6jec to ark r n's Cpe on laws of California." <br /> Signed <br /> __. Owner <br /> By . ............... ............................. .... .......... • . ••------...... Title .. ..... . .. --.......---.... <br /> (If other than owner) <br /> — _-v__•_ -- _ FOR DEPA ENT USE ONLY <br /> APPLICATION ACCEPTED BY . 4. _,_. - -_ ---- ------- -- --- ------- ----- DATE ...5f. �_. . ._......_------- <br /> BUILDING PERMIT ISSUED -. ...... ---_ ._.. .......- DATE .. ..... . <br /> ADDITIONAL COMMENTS ................._ --...._........._. _...... <br /> ............ --- -------------•------------•-- ----- - - ................................ ......... .................................................. <br /> -------------- -- ----....-- -- ------ <br /> Final Inspection by: .. - -..-..---•---------_-------- ......Date . _.._ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> _._....._.._..... ... .._ T <br /> E. H. 13 24 1.'68 Rev. 5M - 7/72 3 M <br />