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FOR OFFICE USE: <br /> APVvfCATION FOR SANITATION PERMIT <br /> 7. .. � <br /> (Complete in Triplicate) Permit No. 7 'S'----••---- <br /> „-, This Permit Expires 1 Year From Date Issued Date Issued ... .._..r._.._.. <br /> pplication 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 /> :OB ADDRESS/LOCATION ..: �f - j f---._l �J.!..... ----.... ........CENSUS TRACT <br /> twner's Name .' -- --. I ___ ----------- <br /> •---.•---.Phone ......_.._._._..__...._...._.__.___ <br /> Address . _.. -�' .....�.0_...._.. `� v.�._. . City ._..�� ------------------------------ <br /> � - <br /> ontractor's Name ..... �. � _..� %~ , <br /> . LA. .. �- ---• --License # ../r�'3_e '_yPhone . <br /> arnstallation will serve: Residence ❑Apartment House 0 Commercial ❑Trailer Court <br /> Motel ❑Other .................. •-_-------------------- <br /> umber of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size ......Y__ _.._.._.._._.___ <br /> Water Supply: Public System and name ---------------------------------------..............-•-_............................................. ----Private � <br /> haracter of soil to a depth of 3 feet: Sand❑ /-Silt Clay Peat Sandy Loam Clay Loam [3Hardpan E] E] E] [JAdobe ❑ Fill Material ............ If yes,type ............................ <br /> 'lot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> ..IEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size................................................ Liquid Depth ...___.__-__-_-___-_-__. <br /> Capacity -------------------- Type •--•------••-----_.- Material...................... No. Compartments ...................... <br /> Distance to nearest: Well ....................................Foundation _._._ ................ Prop. line ...................... <br /> EACHING LINE [ ] No. of lines ........................ Length of each line..........._...........----- Total Length 0 <br /> 'D' Box -.-_--_--- Type Filter Material ____________________Depth Filter Material ............................................ 6 <br /> Distance to nearest: Well ........................ Foundation .......--------------... Property Line ..------__.___...... <br /> ___.� <br /> SEEPAGE PIT [ J Depth ..... .............. Diameter ---------------- Number ......._...... ........ Rock Filled Yes ❑ No QL <br /> WaterTable Depth ......................__•---_...................Rock Size ................................ <br /> Distance to nearest: Well ________________________________________Foundation ..........._........ Prop. Line .....................C <br /> _;EPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- Date __________________.________-------) C <br /> SepticTank (Specify Requirements) ------ -------- - ------ ----------- .__---•-------------•----_______----------••--------_---••---- --•-----••-•--•-••-•---_ <br /> Disposal Field (Specify^Requirements) _ �'� _. . .r _ - ________________ __ ___________________ <br /> rX11 1 2 > <br /> •---•-•---•------------•-•-----••---- <br /> ------------ •---• ----------- <br /> (Draw existing and required addition on reverse side) <br /> 'T hereby certify that 1 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 liven- <br /> ed 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 Workman's Compensation laws of California." <br /> igned --- ............._.---- ----------- Owner <br /> My .... --- - ------------------------ �L'^ir>1- ,- 4 �"� ._..... Title .�'.c>�.zcz�r� .............................. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY ....... .................................................................................... DATE ---- _/..��..�.. -•--•--•----- <br /> BUILDINGPERMIT ISSUED .................... •----_--D---• ._.._..• -----------------------------------------------------------DATE ............................................ <br /> ADDITIONALCOMMENTS ...............................c.a , .. ................_..........._.........._.............._......_...._.__...._....._........__..._.._...._..... <br /> ...........------------------------------------------------------------------------------------------------------------------------------------------------- ---------------­-------- <br /> ----- -- - ---................................................................................................................. ---------••--•---......-•--•--•---•.. .............. <br /> =inal Inspection by: ---------•---•• �f ._.__. Date .. �y.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />