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FOR 0FPGE-A-JSE- <br /> APPLICATION FOR SANITATION PERMIT <br /> -------------­------*-------------------------------- N 3-1/4 <br /> .... .............................. (Complete In Triplicate) _............. <br /> . ................................... This Permit Expires I Year From Date Issued Date Issued .A.3 <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 _ -50 .5_ <br /> .......................................CENSUS TRACT ---- --- <br /> Owner's Name q �7 <br /> ------------------I------­----_---Phone <br /> Address ------ <br /> te A­V­ Q.&-d............ city ------ --A ........ <br /> Contractor'stlT.lwr. .�;- ', --_.r -._ i?._.License # ------------------------ Phone <br /> Installation will ierve.. Residence 'Apartment House 0 Commercial:L]Traller Court 0 <br /> Motel C]Other - <br /> -- ----------- <br /> 'Nurriber46f livingunits:___'/__­Num' b'er of bedrooms'-.13 Garbage Grinder Lot Size ... <br /> Water Supply: Public*System and name --------------------_---_ ---_----_--------------....... --------------- -------------_ Private <br /> Character of soil to a depth of 3 feet: SandClay E] Peat E] Sandy Loom 0 Clay Loom <br /> '_- -Hardpan �Adobe f:j -Fill Material if yes,type.......... ............... <br /> (PI;Dt plan, showing size of lot, location of system in ation to wells, buildings, etc, must be 'placed on reverse side.) �j <br /> NEW INSTALLATION:' (No septic tank or seep pit permitted if public sewer is available within 200 feetj 1% <br /> PACKAGE TREATMENT SEPTIC TANK- Size.. 4 C1,14 <br /> --------- Liquid Depth ...16d............... <br /> Capacity Type ................ MaterialCe-ON.C.AK36,No Compartments ......... <br /> IM <br /> Distance to nearest- Well ..........Foundation ............. Prop, Line---------------_----- <br /> LEACHING LINE No. of Lines ........ .... Length of each line------—4w---------- Total Length <br /> V Box ----------..- Type Filter Material 6-404CIL....Depth Filter Material ...1K__Ft......................... <br /> Dlli;ricie'to.'neia' rest:"Well Foundation 0 n .... . ........... Proofffy-Line <br /> t A e . , <br /> SEEPAGE PITDepth Di meter Number ............*%---------- Rock Filled Yet' No 0 <br /> t Water Table Depth _....Rock Size ................................ <br /> Distance to nearest: Well ------- ---------------------Foundation .................-.. Prop. Line ...................... <br /> REPAIR/ADDITIONIPrev. Sanitation Permit# ---------------------------------------------- Date ................................... <br /> Septic Tank [Specify Requirements) -------- 4c-4?.............. --------•---._. .............. <br /> Disposal Field (Specify Requirements) <br /> ................ -------- .......... -----•-------------------------------•-----..._. -----•---•--.....------- <br /> f ,- .. .._,. __ ------------- <br /> ............... ------- <br /> ---------------------------------_ -------------------------------------------------I.................... <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 Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen. <br /> sed agents signature certifies the followingt. <br /> "I certify that in the performance of the w rk for which this permit is Issued, I shall not employ any person In such manner <br /> performance <br /> 7 the <br /> as to become su?bjec man's Co cation laws of California." <br /> to Workman's Co <br /> Signed --------------I- . ...............I........ Owner <br /> -------------- Title ........ �...... <br /> --------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.----l----'___ .... --------------------- 70- <br /> ..................................I.................... DATE <br /> BUILDING PERMIT ISSUED --------------------------------_------ <br /> --------------------- ---------------------------:--------------DATE ------------------------------------ <br /> ADDITIONAL COMMENTS ------ <br /> .................. ------------------ .. ..... ---------- -------------------------*------------*.......*------*---------------------------------------------------------- <br /> --- -- ------ <br /> - -----•--------------.-.------------------------------•_-------- -----•• ------------------_---------_ <br /> ----------- ---------------- . ... .­­........ ...................... ...... <br /> Final InspecTI rr� ------ ---- -- ---------• <br /> . --------------------- <br /> Date ....1....... .` ..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> .E. H. 9 1-'68 Rev. 5M <br />