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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------------------------- (Complete in Triplicate) Permit Na. <br /> ---------=------ ---------------------------------------- <br /> ------ This Permit Expires 1 Year From Dale Issued Date Issued ----'7- <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 5.49 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION .--- 6d-�-_,__�l � ��J- 1 r���----------------------CENSUS TRACT -------_-----_..._..-----. <br /> Owner's Name -------- --ce���c------- U. 1.-- --------------- __Phone ------------ <br /> -----------------=----------------- ----------------------- <br /> Address - � aT77 / City / C%�--- ------------------------------ <br /> Contractor's Name _-___ �.�t-----�OIZ47 / -----------------------------License # � <br /> � Phone _67' 5 <br /> Installation will serve: Residence P4,Apartment House❑ Commercial ❑Trailer Court i❑ <br /> Motel ❑ Other ------------------------------------------•- <br /> Number of living units:-----/---- Number of bedrooms -_--%-7--Garbage Grinder ------------ Lot Size ------------------------_---___ <br /> Water Supply: Public System and name ---------------------------------------------------------------------------------------------------•-----------Private (� <br /> Character of soil to a depth of 3 feet: Sand=[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam JR� <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 tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------------------------------------------------ Liquid Depth -------------------------- <br /> Capacity -------------------- Typ <br /> e --------------- terial------ - ----------- No. Compartments ------------- <br /> Distance to nearest: We --------------- -____---_..Fou dation _-__________________ Prop. Line -_-_-_--......-....._ � <br /> LEACHING LINE [ ] No. of Lines ---------------___ ngth o each line- _________--__----------- Total Length ----------._ _- .. . .� <br /> D' Box ---_---_--_ Type Filteria ___-__i:--_____- Depth Filter Material -------------------------------------------- <br /> Distance to nearest: Well -- ----� Fouation ----__-----------_---- Property Line _--_---------_----.---_SEEPAGE PIT [ ] Depth -_-------------_-- Dia _---Z---_-_-- Number __-______--_--_____--___. Rock Filled Yes [] No []Water Table Depth -------- ------------ ---- - ockSize -------------------------------- <br /> Distance to nearest: Well -------------- Foundation -------------------- Prop. Line .._.___..________._ <br /> - <br /> REPAIRfADDITION(Prev. Sanitation Permit# --- ---_-------------------- - Date --.------------------------------_) it <br /> Septic Tank (Specify Requirements) ------------------- --------------------------------------o---------------------- <br /> �DisposalField (Specify Requirements) ---_ P-__---- <br /> S <br /> '-"--�•W_7e------Iry Mq-- <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 <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 /> "1 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 Wor an's Compensation laws of California." <br /> Signed --- - --- <br /> ------ --------- - ---------------------------- --------------------------------- Owner <br /> By ------------- " ---------- - -------------- ----------------------- Title ------------------------------- <br /> ---------------------------------------- <br /> [lf other than owner) <br /> FOR DEPARTME T USE NLY <br /> APPLICATION ACCEPTED BY -- -- DATE --7=-I ---------------------- <br /> BUILDING PERMIT ISSUED -------------------- --- ------- ---- --------- ------ DATE ------------------------------------------ <br /> ADDITIONAL COMMENTS ---------------------------------------- ---- -----------•------------------ <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------- <br /> -------------------=------------------------------- <br /> Final Inspection b x$17_-71---_----------------- <br /> p Y� ------------------------------ ----- --------------------------------------• ---- -- - -- ------------Date ------ <br /> SAN JOAQUIN LOCAL HEALT (STRICT <br /> C <br /> E. H. 9 1-'68 Rev. 5M .���� <br />