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r =; <br /> FOR OFFICE USE: <br /> PPLICATION FOR SANITATION PLIC <br /> --------------------------=------------------------------ 7 ► Permit No. <br /> (Complete in Triplicate) <br /> _____________ This Permit Expires i Year From Date Issued Date Issued _9___z..9...../ <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 /> ,w <br /> JOB ADDRESS/LOCATI N .116,5- ------ ------e y------------CENSUS TRACT <br /> - <br /> Owner's Name ------- - _ Pho a ------------------------------------ <br /> Address ---------------------_-- <br /> rt` _.- <br /> Contractor's Name __-- _ _ -. _ -_-�u� - --- License #�1��.`�d�._�'_ Phone -------------------•-----•--•- <br /> Installation will serve: Residence eApartment House❑ Commercial :❑Trailer Court <br /> Motel.E]Other-------------------------------------------- <br /> Number of living units------ Number of bedrooms ._____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 [5/ Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------- <br /> (Pl'ot 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 ublic sewer is available within 200 feet,) N <br /> PACKAGE TREATMENT [ ]. SEPTIC TANK [ Size. _� __ _____ _ _�_-- Liquid Depth ----I/ /.............. (, <br /> Capacity 4.470-- Type�_c�_,_ -- Material--- ---- No. Compartments -- ............ <br /> r-----------------Foundation -__47- --__------- Prop. Line _..__--��"_:� ------Distance <br /> LEACHING LINE [�No. of Lines —__________-- Length of each line_______--_a�_.__-- g <br /> Total Len the .__�_.,p,_�_.___.___. 6 <br /> 'D' Box _____ T e Filter Material ___�.�.�.._ _ <br /> YP. Depth Filter Material ------- <br /> -f,�------------------------------ <br /> Distance t__ __nearest: Well _ _______ Foundation _____1_ --------- Property Line ._.�!_ _ --------- <br /> Depth ___,►2X-_---- _' Diameter _ Number ----------- ---------- Rock Filled Yes 'UT' No <br /> SEEPAGE PIT [IK" <br /> Water Table Depth --------------k0_J------------------------Rock Size INS <br /> Distance <br /> Distance to nearest: Weil -----------/04 �------- -----------Foundation --.----_©.�.---- Prop. .Line........._..._.._._.... <br /> REPA'fRfADDIT <br /> ION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) _____________ <br /> Disposal Field (Specify Requirements) - --------------------------------------------- --------------- e <br />` ---------------------•--- --- <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. Hoene 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 W an's Compensation laws of California." <br /> Signed --------------------By Owner <br /> Title _ <br /> (if other tha owner) <br /> I <br /> FOR .DEPARTMENT USE ONLY F <br /> APPLICATION ACCEPTE17 BY - -----•-----------------------------------------------------------------. DATE __?_791=41"V................ <br /> BUILDINGPERMIT ISSUED -----------------------------------------------------------------•._ ------- -----------------------------DATE --- ------ ..... .......-•-------- <br /> ADDITIONAL COMMENTS -------------------------------- = i <br /> -----------------------------------------------•------ ----------------------------------•--------------------------------------•----------------•-------------------------------------.--- -• -- .--- ' <br /> ` --- <br /> ------------------ <br /> --------- <br /> - <br /> ------- <br /> I <br /> Date <br /> -------------------------------------- ---------• ------ ------ --------- -------- - ------------------------------ <br /> Final Inspection by. SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M !/ <br />