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FOR OFFICE USE: <br /> ` <br /> �&PI.ICATION FOR SANITATION PE%T,._.-....._._.__.---.--.--.-------.-..___-- Permit <br /> (Complete in Triplicate) <br /> No.l.�.'............. <br /> - ----------------------------------- --- <br /> --------------------------- <br /> ----------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued <br /> ti <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,pppl�tion is made in compliance with County Ordinance No. 549/9 and existing Rules and Regulations: <br /> JOB ADDRESS/ N ._ _L.... ._ --- -- ----- : ---- ----�s�' c-![_CENSUS TRACT ­.-S-1-7 - <br /> Owner's Name ----- ---- ------- ----------- - - -----..Phone ------------­­ - .............Address -------- 1 a ---------------- ....... - - City <br /> Contractor's Name ---A __ ... _ "� � '__---.License # l�y32 Phone --------..................... <br /> ---- ------ -------------------- <br /> Installation will serve: Residence [ partment House Commercial [-]Trailer Court 0 <br /> r Motel ❑Other- ------------- ------------------- <br /> Number of living units:-----(_----- Number of bedrooms--- ---___.Garbage Grinder -------- --- Lot Size -----s-'--_'.".------ ............. <br /> r <br /> Water Supply: Public System and name ------ ----- ------ ------­---------- -------------------------------I----------------------------Private <br /> Character of soil to a depth of 3 feet: Sand I-] iIt F] Clay E] Peat E] Sandy Loam ❑ Clay Loam C]Hardpan Adobe❑ Fill Material --------__ If yes,type _.....................___ <br /> r <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: (No septic tank or seer pit permitted if public sewer is available within 200 feet,) <br /> kl <br /> PACKAGE TREATMENT [ I SEPTI TANK f • /� Size j__,�.14.._.X._ar..___.__._._____ Liquid Depth _.�'.------.__.-...... <br /> Capacity -6?p. .L Type __... . _--... Material___-�aP"_:An No. Compartments.............. <br /> / r <br /> Distance to nearest: gWell --------Z�P...................Foundation ---(4_...-___. Prop. Line ._s,.--....._... <br /> LEACHING LINE ](Y No. of Lines _._.-_.._ z._._. Length of each line-- .......... Total Length _.__l .4...--._-- - <br /> 'D' Box -----/_.. Type Filter Material ........$.2. q ._Depth Filter Material .....tlf__-----------------_.--....-- � <br /> Distance to nearest: Well ------- Foundation --------LQ_ ----_. Property Line --------.�� ...._..-0 <br /> / w <br /> SEEPAGE PIT Depth __.a��. ___ Diameter _._ s�----------- Rock Filled Yes No-3�--�'/-'----- Number - - . O <br /> r / >> <br /> Table Depth ..............�Z?_._--------.---------­--- <br /> Water Rock Size <br /> _ 1 <br /> Distance to nearest: Well ___.__-.1_b�.....................Foundation ....L.12._ ..... Prop. Line ..._....._----------- l.' <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ------------...........-----------) D <br /> .. Septic Tank (Specify Requirements) ---------------------:----------------------------------•-----------------•-----------------------• --------------- ----- TX <br /> Disposal Field (Specify Requirements) ----------------------.........._------.._..------------------------------------------------------------------------------------- <br /> ---------------------------------------- <br /> 1 <br /> ----- ----------------------------------------------------------------- ------ -------­------- - ------------ --------------------- ----------------------------------------- _. <br /> (Draw existing and required uired 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 Compensation laws of California." <br /> Signed ---------------------------- --- ------�- V�«} ..---- -----. Owner <br /> By --------------- ------------ -- C.i `- ` . Title . �L/1�LA Qxyi <br /> .. (If other than owner) <br /> FOR DEPARTMENT USE ONLY G� <br /> APPLICATION ACCEPTED BY - ---------------------------------------------------------- DATE .-L--.' �. .�L ........... <br /> BUILDING PERMIT ISSUED ------------------------------------------------------------------------------------ --...------------DATE ------------------------------------.. <br /> ADDITIONALCOMMENTS ---------------- - ----- --------------------------------------------------------- ----------------- --------------- ------------- <br /> --------------------------------------------------------- ---------- ------------------------------------------------- --------------------------------------------------- <br /> - ' . --- - ------ ,�2 t} <br /> Final Inspection by: -- - mile?.. - - ------------------------ ---------Date �----- -- <br /> L SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />