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FOR OFFICE USE: <br /> APPLICATION FORSANITATION PERMIT 9 <br /> ••. ............. <br /> 7. <br /> (Complete in Triplicate) Permit No. ...................... <br /> This Permit Expires 1 Year From Date Issued Date Issued <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 .... CENSUS TRACT� _ �'�'"'`t � _"fix�. <br /> ------ ..... .......... _.... <br /> 1­1Owner's Name . ?-�.;.._..._ _......_....-•--•---.... ....'�- - .............Phone ........) ........................ <br /> Address . ....LYa� ._ _ ��`1... `N_.h .------. Cit' -- _ CJ✓Q•t �- <br /> -_--_ <br /> - _ ------_-.- <br /> Contractor's Name .__-.. ......�y�-.- ............-• ----- �+ �--_ t,---License # _lZil-3t YPhone ........................ <br /> Installation will serve: Residence[]Apartment House❑ Commercial❑-Trailer Court ;❑ <br /> Motel ❑Other_...` % ...1.. * <br /> Number of living units:_....r..... Number of bedrooms ._ .._.Garbage Grinder ------- Lot Size ............................................ <br /> Water Supply: Public System and name ................._..................................._.-------------..-...-.---_ -----------__----------_--Private l'" <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat 0 Sandy Loam X 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 TREATMENT [ 1 SEPTIC TANKSize X.._9_-.x_1 _•j.....__ Liquid Depth .. ._..._.__.________ <br /> LIV <br /> Capacityl .C._ :Type -s�.!_ Materiol..9�k?::�.. No. Compartments _.. .._ p <br /> Distance to nearest: Well ............ ..'.ep........... <br /> ._-_Foundation Prop. Line- .............. <br /> LEACHING LINE [� No. of Lines . ------:!.............. Length of each line-------/_0.Q........... Total Length _____t .!2.1___...... G <br /> D' Box __----.. Type Filter Material .....S.._. ....Depth Filter Material .....,r!��............................._.._ <br /> Distance to nearest: Wel! .___ ..._......... Foundation ------•1..9........... Property Line _.___` ------ <br /> T Depth .__ <br /> �Q .___ / Diameter ! r <br /> I ,f�'__.__. �...X 14- Number .___.._,�...4.._///___._ Rock Filled Yes,�t No �r <br /> Water Table Depth ................ ?........-........_--.-.-Rock Size -.�..1 __X..-/ <br /> Distance to nearest: Well .............J� _---...-...........Foundation ........1... Prop. Line .-S................. <br /> REPAIR/ADDITION(Prev. 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 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 Workm s o pensation laws of California." <br /> Signed ....... _....... ------------ -- ------ Owner <br /> By ..- -_.... . a +---`�--- :C - Title .3.. r--..� -_...... - . <br /> ----------------------------•- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- _.. .................. ...................... ------------....._.__ DATE _...4'-..7-__?" ........... <br /> BUILDINGPERMIT ISSUED ............................_.....................•--.__-•------------••---.----- •-_--•---•-----DATE .._....-- ..............•---...._..... <br /> ADDITIONAL COMMENTS .............. <br /> --•--•----------•----••-•---•-•------------•--••--••-----------------------••----------------_----•--..------•-- - <br /> ---••---------------------- - . ........._-.-....................._.._............ -- .........-•----.............__.............-- ......... <br /> ............._- ------------ ...... _. -----------••--- ............. 1---......----------------------- <br /> Final Inspection by: - _. .... .�- . .-.._ . .. <br /> - -----------------------•--•---..........-----...------ -- - ... ,...Date ---- •--y . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1•'68 Rev. 5M <br />