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FOR OFFICE USE: v APPLICATION FOR SANITATION L.,AIT <br /> -_. ----................ .. Permit No. <br /> IComplete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued ...c�..: <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/LO ION .`�-� - n--_---- ..-.1../�--.--.-. CnG .......CENSUS TRACT .-..-------------- <br /> Owner's Name .__. - ..---- ........... ................. - .. . ... Phone ---------------------- . ... ...... <br /> Address _A//------ - ... ._."� .............. - .. City - - ................................................. <br /> '�}} <br /> Contractor's Name -... . . --- ----.- ----- --------------L. ,License # /&3&0_ Phone .............................. <br /> Insta[lationfl� Residence Apartment House Commercial ❑Trailer Court 0 <br /> (/, \\ Motel ❑Other .................. ..---- -------------- <br /> Nu \ 'l g units:.....I----- Number of bedrooms ..3.--- Grinder ------------ Lot Size ------ d ---.-...- <br /> Water Supply: Public System and name ----------------------------------------------- .................... ..........-_..................Private <br /> Character of soil to a depth of 3 feet: Sand C]/Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan Adobe ❑ Fill Material ............ If yes,type .___-- -----.-..__-.... <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 seepage pit permitted ifpublic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK-i'Jp/ Size- <br /> � ' ­/.l�Z'Z-17._ .--__ -._----- Liquid Depth ....`. -------------- <br /> Capacity 1Via.-q.K Type - -.--_.c-- - Material X No. Compartments .-.ems ............ <br /> Distance to nearest: Well -- ---------- ----.-----.Found((a//tion --.-- ----_ Prop. Line ...s.�......... <br /> � <br /> LEACHING LINE [� No. of Lines ___ 9' g 7.. g <br /> Length of each line_-.--.-- R_ __ Tota[ Length ....� !*.. ... i <br /> D' Box _4—_. Type Filter Material -._._c5.2.t--Depth Filter Material ------/.f.. ............................ <br /> Distance to nearest: Well a___�c_�.-_-. . Foundation <br /> -ck Size C./ � -M1 Property Line �.$� .................. Z I1 <br /> SEEPAGE PIT [� Depth ..._-�--_`r-/�,-'/-Diameter �-�-��-. Number �.-----_.. Rock Filled Yes No �❑ <br /> Water Table Depth k)L-- <br /> Distance to nearest: Well .----- ---b e..K.....------Foundation ....157 .- Prop. Line ....6-., <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---..............................) <br /> SepticTank (Specify Requirements) --•-------------------------------------------------------------------------'---•------------- ........................................ <br /> Disposal Field (Specify Requirements) ..................... - ------------------- ---------------------------------------- ............................................ <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. 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 Workman's Compensation laws of California." <br /> Signed _.... / <br /> ........ ..... }.� ..--- ----.-_.._ Owner <br /> By aPit�i IJ�. ". "I" Title Title . ------- ----------------------- <br /> other than owner) <br /> FOR DEPARTMENT USE ONLY 7 <br /> APPLICATION ACCEPTED BY .. --- ' 4 - ----------------- ------- ---------------------------------- DATE - /3-........ <br /> BUILDING PERMIT ISSUED - --------------- ---------------------------------------------------DATE --------- <br /> ADDITIONALCOMMENTS .- -................. .......................................... - ----------------------------------------------- .......... ........................, <br /> _...._..__..-......... - ---------- --------------- .................................-------- --------.......-------------------------------.....---.--------.._..------------ <br /> _ . .- - <br /> ------------------------------------ <br /> - - - <br /> Final Inspection by: --- - --'l- -- -Lrt- - ------------------------------...__---------------------------Date --- ----70 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />