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i <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> L..... <br /> ................................•- •.....I. Permit No. .�3.`.GQ7.. <br /> (Complete in Triplicate) <br /> .............................. <br /> . <br /> ............................•----------.--•--...... This Permit Expires I Year From Date Issued Date Issued .?��Q-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 .{ ._7-s ..._../.,r!.�°.-. � __1�.. .. ............. .CENSUS TRACT __.. -:-..::_:.....•... <br /> ....... ..........Ph n ......... ..............•----•.•--- <br /> Owner's Name •-- � f�.• ff ._.......... = ��..��. <br /> : ,�.. .._ .. City � ��'k-..•..._�- <br />[ Address <br /> ................:..........: <br /> Contractor's Name .._._._.. e •••--•..............License # ,`� /�s <br /> Installation will serve: ° ' Residence,0 Apartment House Commercial QTrailer Court 0 <br /> Motel ❑Other - _ <br /> Number of living units---- Number of bedrooms .-.P�--_..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 C-) <br /> Hardpan ❑ Adobe:❑ Fill Material r`. .-.:---._ If yes,type .............-----------•-•- <br /> L <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: (Noseptic tank or <br /> p seepage pit permitted if public fewer is available within 200 feet,[ <br /> I <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size. ¢C'a ----------- ........ Liquid Depth _� ------...,....- <br /> Co p acit � ...... Type Material e.pov,-_t... No. Compartments ... ............... S <br /> P Y� or . <br /> Distance fio nearest.// Well '��. ;>roundation .� -••.-• ... Prop. Line . .. V1 <br /> Nol of Lines ....___f.............. Length of each line. .. _e------:•_.... Length -------- <br /> V <br /> 3 LEACHING LINE ' Total Len r.----•- <br /> 1 '� <br /> 'D' Box - Type Filter Material ... ..... Depth. Filter Material __, ....-------- <br /> - Foundation _ .:�............:: Property Line ...-I .•--••--- <br /> - Distance°to'nearest: Well _...i'.. ...- . -•- <br /> SEEPAGE PIT Depth .-.s -•.. Diameter .... Number __._... '.............. Rock Filled Yes No <br /> j ❑� <br /> t Water Table Depth ---..••. �,; •-.......: .._•-:_..... - <br /> .Rock Size ��'� <br /> Distance to nearest: Well .___ � ......................Foundation ..._ ...�-___ Prop. Line f� _- <br /> i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date - .-••--------_•---------------- <br /> Septic Tank (Specify Requirements) -----------------`----------- ...........................------------------------------------........................._•----------- <br /> Disposal Field (Specify Requirements) .................--................................................................ =-------------------------................. <br /> a <br /> ------------ <br /> -. .....----------------- <br /> -- <br /> t .....--•--- <br /> r --- ----•---- ----•---------------•--•--••---------------•--------------•----- •---------------_---------- <br /> (Draw existing and requiredaddition on reverse side) <br /> 1 hereby certify that i have prepared this application and that theworkwill 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 /> °'l certify that in the performance of the work for which this permit is issued, I ishali not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ............. •----- -- -•-••-•-----••-- ........... Owner <br /> + <br /> By r' Title f` :................. <br /> ' ---•••---••--•------------- - <br /> (If other th i wrier} <br /> POR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- ------- - - ----------------------•-................... ------------• DATE ...1. '•7Z-----------. ------ <br /> BUILDING PERMIT ISSUED ---DATE <br /> iADDITIONAL COMMENTS ...................•----.........----------•-----......------....-_-...-•-- ...............................................-------------•...................... <br /> -••---------•-•----------------•--•-................... .e.-------•..........*........--..-4..........................................................................................*..*...-.-..-..-..-..-..-..-...-..-.­.....*.........w..............................................-..-*.-..-..-..-.-...-..-..-..-....*-..-.-.-.--.-.*.-..--.-.-..--.-.-.-...-.-.-..-..-..-..-..-..-..-..-...-.-...-.-.-..*..............-. ---------._..............._.......--••-----:......--•...............----•--. ._....•----.---•------.............._.._.. <br /> = :.- <br /> Date - �. .................... <br /> Final Inspection by: ..f.7���•�.� ....... ........ .. <br /> _n _ ,SAN,JOAQUIN,LOCAL HEALTH DISTRICT <br /> 7/72 3-M <br /> ��. 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