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FOR OFFICE USE- <br /> 6 APPLICATION FOR SANITATION PERMIT <br /> ..............•--....................._..? ........ <br /> (Complete In Trlplicatel _ Permit No. ..7�`.......... <br /> ..................................I.._............ This Permit Expires t Year Frani Date issued <br /> Date Issued 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 ' made in compliance with County Ordinance No. 549 and.existing Rules and Regulations: <br /> JOB AQQRfSS/LOCATI tCENSUS TRACT -------------------------- <br /> Owner's Name ... .. -- ........................................... ............ . Phone ....... <br /> Address -----....-•----------------1'` ��� . !...... <br /> ..................:City ... .... . .......... ...... ---•---- ----- <br /> Contractor's Name ----- ...... ...--- .. a. .....L€cense# .3.._ . ..!"Phone <br /> ........._.. <br /> Installation will serve: Residence C]Apartment House fl Commercial OTrailer Court [3 _t <br /> Motel 0 Other..- ,. ! , <br /> Number of living units:............ Number of bedrooms ............Garbage Grinder ............. Lot Size,- ....... <br /> .................,..._.-_.._._.... <br /> •_ �r i <br /> Water Supply: Public System and name ........................................................_......._...........I....................._........Private <br /> Character of soil to a depth of 3 feet: Sand E] Silt C] Clay .0 Feat 0 Sandy Loam Q Clay Loam� V <br /> Hardpan 0 Adobe Fill Material —......... If yes,type....I........ ... <br /> (Blot plant, showing size of 'lot; location of system in relation to wells, buildings, ett. Must be.-,P oin,reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit ,permitted if public sewer is available within.200 feetA V <br /> PACKAGE TREATMENT ( ] SFTIC TAMC- Size.......... __2C- ---------------- -----. Liquid Depth _--- <br /> Capar�ty&v._ . Type, N. ,Material..��... No. Compartments ...................... <br /> w r._..'., t r ) 1 i <br /> Distance to nearest: Well ...f -.: :x: Foundation .._..A....... Prop. Line .-S: ...... <br /> LEACHING LINE No. oftines ........1-------------- Length of each l€ne....../..0 _ ........ Total Length .� ._......_r_.__.._..•... <br /> 'D' Box .._.._:___-. Type Filter Material Depth Filter Material ---. ........••---..................... <br /> Distance to nearest: Well Foundation ----- Pro'party, Line .............. . <br /> SEEPAGE PIT ( Depth .--...` Diameter ::_.----.-y_:. Number ......._. .............. Rock�qw Yes P No o <br /> Water fable Depth__ - ..................- , {tock Size,_ --- � iiX Iz <br /> Distance to nearest: Well 1.4...................Foundatlon ._ f".�.__.t.. Prop. Line <br /> REPAIR/ADDITION(Frev. Sanitation. Permit# ...:..:.................•--•-•..-•.- Das -.•---.................._.l <br /> Septic Tank (Specify Requirements). ................................................. .................. <br /> -- • --= <br /> Disposal Field (Specify Requirements) ...................-------,............ ...................................................... -••----••••------•---- <br /> ------------------------•------------ ------------------- ...........I.-............. <br /> ........... - ---------------------------------------------------- --------- - <br /> -------------- ---- <br /> I ------------------------- --- -------------------------------------------------------------- ---••- <br /> -- - - <br /> (Draw a dsting,iind required addition on reverse side) <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with Sart Joaquin <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local HeaIIh:.Districi. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the world 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 . . . r Owner------ <br /> .BY - .. .•......... e ..---•-------.........•-•-•--- Title <br /> -- <br /> if of er th own <br /> s=ue FO EPARTMEN SE ONLY <br /> WPPLICATION ACCEPTED BY----------- -- -- --- -------- ------------- •-------- -----------..........I...... DATE ....f.^.?� r �-- . - <br /> BUILDING PERMIT ISSUED -------=---------- --------------------- ........ --------- ­­­-----._....------- ..............DATE ------------------------------------- .__.. <br /> ADDITIONALCOMMENTS .....-•---•-------•-- -------------•--•----- -------- -----------*------.----------•--•-------•---------.....-------------------•--•-----_-----._..--- <br /> ` r'---•-•-------- • <br /> ---- -- ---- ------------ <br /> ------------------------------- ...... ---• ------•-------•-----......_......-------._._...._._......_...---_..... ..... <br /> . .... ............................... ------------------------ -..... �;.... <br /> FinalInspection by: -•-------•_... . --- -- •-- ----------- €............. .....•-----._..._.._._...........---......_._._©ate ..�- ... ------ ' <br /> EH 13 2h 1-68 1kv. jM SAN .iOAQUIN L AL HEALTH DISTRICT 8/7h 3M <br /> i <br />