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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 7�_ �.y <br /> Permit No: --- <br /> (Complete in Triplicatel <br /> --- ----- �1 � - <br /> _________________----__ -_-_ This Permit Expires I Year From Date Issued Date Issued -- "_" y <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 ._ ___ __________ -------------- CENSUS TRACT ________ �. <br /> • O'D----- --- ; Phone _l __: ' <br /> Owner's NameY :r s = <br /> Address,17/. 5 - 71A- -X) --------------------- City /l a( -------- < - . <br /> Contractor's Name ------- -- ----_--l� _fz�_ �------------ -----------------------License # � :. r Phone <br /> Installation will serve: Residence-'Apartment House❑ Commercial :❑Trailer Court ;❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:__.___.._ Number of bedrooms z-----Garbage Grinder ------------ Lot Size ----________________________________________ <br /> Water Supply: Public S)tstem and name ----------------------•-------------------- -- ---------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'[-] Silt❑ Clay;g Peat ❑. Sandy Loam ❑ Clay Loam ❑ fi <br /> Hardpan 0 Adobe ❑ Fill Material ------------ If yes, type <br /> (Plot plan, showing size of lot, locatiol f 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,) t <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth ------------•---------_._ , <br /> Capacity ----------- ----- Type -------------------- Material ------------------ - No. Compartments ------------- <br /> Distance to nearest: Well ------------------"--__-------- --Foundati ---------------------- Prop. Line ---------------------- <br /> LEACHING LINE [ ) No of Lines ------------------------ Length of eac ine-------- _______-_._--___ Total Length ----------­-----­--­----- <br /> 'D' <br /> _____-_. -___-_.--.:._.-- <br /> ,� 'D' Box '----------- Type Filter Material _____ _D th Filter Material ____________________ <br /> Distance to nearest: Well ____________________ __ Found ion _________ Property Line_ -------------------------- <br /> L <br /> ______.______--.:-=.: <br /> SEEPAGE PIT [ ] Dep -------------------- Diameter ______ _________ N iber _________.______ Rock Filled Yes ❑ No i❑ <br /> Water Table Depth ------------------- -------------- ------------Rock Size ------------------------' <br /> Distance to nearest: Well _______ ______________ __________-,__._Foundation -______________ ---- Prop. Line "-_-_..__.--_.---- . <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- _ ________________ Date _-_____.________________________} <br /> Septic Tank (Specify Requirements) --- ---- <br /> Disposal F pecify Requ.irements) -------------- <br /> ----- ---- ------- ---------- /-----------------------------------------;�f � /' ---- -------------------e---------- 9'------ - ----------------------------- <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 /> "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 Work n's Compensation laws of California." <br /> Signed - -- -------- ---------------------- `- Owner <br /> --- - ---------------------------- Owner <br /> ----- -- r -,--"-- - � �=�- --- -------------- ------ Title ---=--------------- I <br /> ------- ------------------- <br /> (I{ other t an owner) <br /> FOR EPARTMENT USE ONLY _ <br /> APPLICATION ACCEPTED BY ------ =------------------------------------------------------- DATE ----- -7-4--------------_— <br /> BUILDING PERMIT ISSUED _------------------------- ------------------------------------- --- -------DATE --------------------------------- <br /> ADDITIONAL COMMENTS - <br /> ------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- ------ <br /> ------------------------•--- <br /> ----------------------------------------------------- <br /> - - - - - -- ------ <br /> -- <br /> Final Inspection bY- Date ......-- y !�-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r <br /> E. H. 9 1-'68 Rev. 5M <br />