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.....----- APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. .��._:�7 y <br /> ............................... This Permit Expires 1 Year From Date Issued Date Issued ._$1- :2,P-76 <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/LOCATION ..l l�.__. fl ctf!' (. ../11P . � .� <br /> /.mac <br /> L/ ;.. ENSUS TRACT .................... <br /> Owner's Name _.-..\,.!___f � ( =�� n <br /> ---- .. <br /> - -••••---•-• ........ <br /> ............ Phone .Address .... ..'.?„� �'._.. <br /> � --...................-.................city --- <br /> Contractor's Name ----------- = �ir � - <br /> - ----- -------•--------•-•-•---------.License # .. ..y. ..... Phone .............../ <br /> Installation will serve: Residence E]Apartment Hoyse❑5ommercial ❑Trailer Court <br /> Motel ❑Other�c�._ Atk-z -- ,_,_ <br /> Number of living units:-------- Number of bedrooms ............Garbage Grtr�der .... Lot Size ------------------------------------------ <br /> Water Supply: Public System and name .._---- c {� <br /> ....... ---• ....•--•-•----•-....Private ❑ <br /> Character of soil to a depth of 3 feet: <br /> Sand I-] Silt p 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 if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENTv SEPTIC TAMC I/ Size..., �;�_ .......................... Liquid Depth <br /> -----• <br /> .. ; <br /> -•--..•••- <br /> I/ - � <br /> Capacity �� � Type ....... Material..�/1Zo!-:L_. No. Compartments ..- ........... 0 <br /> Distance to nearest: Well .................................... ---- ••-�............ Prop.Prop. Line ... ......... d <br /> LEACHING LINE �j No. of Lines .._._._._r/_ I <br /> t � - ---------- Length of each line..-----�.��.-.---.------ Total Length ----1� .......... <br /> 'D' Box ......... . Type Filter Material ._&'4'' ....Depth Filter Material ........lc ..r� _ <br /> Distance to ne rest: Well ....................`.. Foundation .... ............ Property Line ., ............... <br /> SEEPAGE PIT Depth ___ -_-__... Diameter �...... Number ---------- ---- - ......... Rock Filled Yes No ❑ <br /> Water Table Depth <br /> ..............................•---------•--.....Rock Size <br /> Distance to nearest: Well -------------------------..............Foundation ..._ Prop. Line ---:5....;......._.. <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ----------- •-•---•-.--.---••-----.._-• Date ----------------------------------) <br /> SepticTank (Specify Requirements) ---•---•---••-•--•--•------•---------------•-•--•--•---•---•----------------......_----------•--•--------_-------------------------------- <br /> Disposal Field (Specify Requirements) --------------------------------- <br /> ----------------------------------------------------------------------------------------------•----••---........-•------- ........................-...................................................... <br /> -------•----------- - ---------------- ------- ------ --------- -------------- ------------................-................. -----------------------------•-•------ ................................. <br /> (Draw existing and required addition on reverse side) <br /> I 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 licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------- Owner <br /> �/y l ' <br /> BY - - -_L.-1�-- ....---•: F•-------���-------- ------------ - ........ --- ------ <br /> (if other thar�'wner) <br /> rX FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - DATE .. - 7/.............. <br /> BUILDING PERMIT ISSUED .. ........ ... D E _..._... .._.. <br /> .... <br /> ADDITIONAL COP�IMENTS ..�D-0 - -----��--��-.1-��-� ........................L� �. �Q � - ...'_... . <br /> ----------------------------------------------------------- •---•---..•--•................................... ................................. .......----------------------.........-....... .......... <br /> ----. --------------.-------------------------------•---- - ­----------------- <br /> ------------ -----_-•---------- .......... --•---•------------- --.....--•------•------------•--•------/r---••/--- <br /> ----------------.----•- <br /> - -----•---•-•----- •-------- <br /> FinalInspection by: ---- - - ------ -- ----- ----•-------- ••-------------- ............................. <br /> EH 13 2I 1-68 1 vN JOAQUIN LOCAL HEALTH DISTRICT / 8/74 3M <br />