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FOR OFFICfLOE:. -~ APPLICATION"FOR SANITATION PERMIT <br /> ------------ - --------- ------------------------ _. .Y.9. <br /> (Complete to Triplicate) Permit No.7L <br /> ------------------------- <br /> ' This Permit Expires 1 Year From Date Issued Date Issued <br /> 2 � <br /> Application is hereby made to the 5 n Joaquin Local Health District for a permit to construct and install the orkherein <br /> described. This application,is made ia_compliance with unty Ordinance No. 549 and existing Rules and Regulations: <br /> Lao JOB A i RE ILOV a.� o ff ..L. a - ..CENSUS TRACT <br /> JOB ADDRESS/LO ATION ._. .-.. ,_-_ <br /> Owner's Name e - - - s . . - - -... Phone -------- <br /> -. -- ----------------­---- <br /> Address <br /> ------,._.„--.-.-. <br /> Address --------------A. 1_ � -.C�7..�/ r' ---"-_-�-1- --- City -- .�.. ..QLV.. .. ....4_°....------------------ <br /> --- --------- -- ,�Q <br /> � //}( i�tL� <br /> . <br /> Contractor's Name ...___ _... _. .. N:k[2....* _-IS .1.11 f.,__--._.--:___.__License #/4t?06--U.-._ Phone4_f9.(r1-_71. .7.... , <br /> Installation will serve: Residence 0 Apartment House❑ Commercial. Trailer Court !❑ 1 <br /> • r <br /> Motel ❑Other.. - ,_._. __. ____. . . <br /> �1 `1 <br /> Number of living units:............ Number of bedrooms .___.__-Garbage, rinde _.___ Lot Size . <br /> Water Supply: Public System and name -------------------_.......................... -._...-...-.--.-......---..........-.-.................Private 4 <br /> Character of soil to a depth of 3 feet: Sand)vSih G77-.Clay ❑ Pe-at❑ Sandy Loom 0 Clay Loam I] <br /> Hardpan❑ Adobe FiI)Material <br /> � . <br /> (Plot plan, showing size of lot, location of system in.relation,.to_wells?ba(dings, etc. must be placed on reverse side.) , <br /> NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) O <br /> PACKAGE TREATMENT [ ] SEPTIC TANK.�c�ff r� Size _ .. _�XS-_---.---__-_-'-_ Li uid De th-.� t- _...._-- <br /> Capacity '.�+(,M1J- 4L. Type?)!EO/ 7___ MaterialuT 4d_U&_ Nos Compahrt�ents, - --.-...... O <br /> Distance to ne res\\t: Well .2.QQ.......................Foundatipen Y.Q----....--.--. Prop. Line -.l ............. <br /> LEACHING LINE No, of Line' Z.1..._._._.. Length of ea`,y_hJliime_ .Q0_-.-____. . Total Length ��dQ_____.__... <br /> 'D' Box �(�..&. Type Filter Material �.a_ .__._:.. .Depth Filter Material ---------­P............. <br /> Distance to nearest: Well : .Q.l�.--......-- Foundation -5 ............... Property Line IJ_........... . <br /> SEEPAGE PIT [ ] Depth Diameter ......._...... Number ............................ Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ..---.....---......-----......................Rock Size ................................ <br /> Distance to nearest: Well -------------.__------.__----_-----Foundation .......... ......... Prop. Line ....-----_----------- T <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .--.--.---.--.--....----..----....) I <br /> Septic Tank (Specify Requirements) <br /> Disposal Field ISpecify Requirements) --�_.-_._ ._....................._.... j <br /> ---------------------------------------------------------------------. <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 he 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 ' the perfor nce of the wor for which this permit is issued, I shall not employ any person in such manner <br /> as to becom s Iect to W man's Comp satien laws of California.” <br /> Signed ---. .. - - 4$' --- ------`- --- ----------- Owner <br /> By .-..-.. . - - Title -.... .. <br /> (If other than owner) <br /> p FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY........... .._S-[J- �Z.s._.-.-..... ............................. DATE -- -- r--- ~------�-----_ <br /> BUILDING PERMIT ISSUED ----- - -------- - -------------------------------------------- .........DATE .-------- -_........-...... ... <br /> ADDITIONAL COMMENTS - ----- _.. -... ----------------------------- - <br /> -- - - ---------------- ----------------------------- -------------------- -- - . <br /> ....... --- - - - - -- -- ---------------- ........................................_.----- <br /> - - - - . -- ........__..... ............ -- <br /> -- J" <br /> Final Inspection by; . _.__ - -- -- ------- ---- -- -- ­ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />