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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) <br /> Permit No. . ._._..J�° 7 <br />......................................................... <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 /> described. This application is made in compliance with County Ordinance No: 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION �ip [?.....,.YY41..,(11CI. '��,t`, ' <br /> CENSUS TRACT ........................... <br /> Owner's Name .. 6 .. /s iC .__...T...................... <br /> .•--•- ........-•----...:....:_......._._..__.Phone -.-.....................•. <br /> Address ._.... f �'.........................'_._..._.......__.._..-•---------------......... City 77w -... .------._-------------_.-.-----......................... <br /> Contractor's Name .............................................License #a.,7 X?,9.-... Phone <br /> Installation will serve: Residence JX Apartment House❑ Commercial ❑Trailer Court ❑ t� <br /> Motel ❑Other ............................. -•---• ....... I <br /> g ....__Garbage Grinder���'_ Lot Size,5 lA?W/Z.� .._...... . <br /> Number of living units_/..---- Number of bedrooms _ ` � , ••-•,--„-, <br /> Water Supply: Public System and name ----- ►j ,f1 1 "..1 �._._................. ------_----------_....._.......Private ❑ �' <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam gg­ ' <br /> Hardpan C] Adobe ❑ Fill Material ............ If yes, type ..............._..---------- <br /> (Plot pian, showing'size of lot, to ation 'of: syste in relation to wells, buildings, etc. must be p ac verse side.) <br /> NEW INSTALLATION: (No septic nk or seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT [ ] SE ”. Liquid Depth ..__ ................... <br /> Capacity ....:............... Type ...----------------- Material.................... . No. Compartments ................... <br /> Distance to nearest: Well ....................................Foundation . --.----------------- Prop. Line -................ <br /> LEACHING LINE [ ]n _No. of Liles ......................... Length of each line......... __-... Total eng <br /> D' Box . Type Filter Material ....................Depth Filter Material .. ......... ........ <br /> h Foundation . Property Line ._ <br /> ti.. Distance o nearest: Well ...._...--•-........ ..- ------........ ........ __.....-----._...__. <br /> SEEPAGE PIT [ } Depth .. .......I---------- Diameter ................ Number __........,........ _.._.... Rock Filled Ye ❑ No ❑ <br /> WaterTable Depth ' ===:.:...---•---•--•••.._.....---••--•----•... ize -------•........................ <br /> Distance to nearest: Well ........................................Foundation _..:..-----.------.- Prop. Line -----...._.__...._... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .•---•---.......-........._.......) <br /> Septic Tank.(Specify Requirements) ............... ................................................................._..... .. <br /> - <br /> Disposal Field (Specify Requirements) ,, ....-r1� .1 �-- ----,lsy l 47 -.+ e ----------- <br /> �� <br /> ........................ ................................---- <br /> (Drciw existing andrequired ` <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 /> By ...............• --_.... . ._....._._..------••----......---•-- Title <br /> (If er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY ------- ....................................-------------------------------.--_..................... DATE .......................................... <br /> BUILDINGPERMIT ISSUED .......................................................... .....--.........................................DATE ........................................... <br /> ADDITIONAL COMMENTS .................. .•-------------•--..................._............. <br /> --•............................•------------------•--......--•-•-----------------.............--•-•-........._...• ........ <br /> Final Inspection by: .......... ............. ....Date .. <br /> SAN JOAQUIN LOCAL HEALTH � RiCT <br /> E. H.13 241-'68 Rev. 5M — 7/72 3 M <br />