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FOR OFFICE 0,5 <br /> APPLICATION FOR SANITATION PERMIT A- ZP, <br /> -------------�V------------- <br /> (Complete in Triplicate) -Perm it,N81- ------------ <br /> ----------I--------- ------------------------------------ <br /> �e <br /> A� '�Ddtd Issuid <br /> --------------------------------------------------------- This Permit Expires 1 Year From 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 Fn6cle in compliance21th Comy O�rdl a eko. 549 and existingIRvIes and Regulations: <br /> d <br /> ..... ... . ... <br /> I <br /> JOB ADDRESS/LOCATIONf.;_4 - - ----- ------------- ------ - ----------------CENSUSJTRACT <br /> Owner's Name < t-CF ----------------------- -�-------- Phone- <br /> ----------- <br /> Mr <br /> Address <br /> ----------------------- <br /> City <br /> Ze.��- __.License o_2�14117_142__ Phone ------------ <br /> 3- ozf� <br /> --------------- <br /> --------------- <br /> le <br /> Contractor's Name -i _ez <br /> Installation will serve: Resijence�X, 'jApartment House,0 Commercial :E]Trai let Court iE] <br /> Motel-.G] Other J---------------------------------------.. <br /> Number of bi 9-.--..Garbage Grir)der -------- ot e---------- 0------------ <br /> Number of living units.----/- sirooms !_c <br /> W - Private El <br /> Water Supply: Public System and name ------ 14 <br /> -------------- -- --- <br /> Character of soil to 'a depth of 3 feet. Sand It E] Clay E] Peat <br /> "�] _] Sandy Loam El 3^ Clay-Loam 0 <br /> Hardpan'El Adobe Fill M' <br /> ' aterial __.--------- If yes'type ---: -- <br /> kl- ---------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.1 must be placed on reverse side.) <br /> �1. . 1 .01 1 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avail ble with)n.200 feetJ <br /> PACKAGE TREATMENT SEPTIC TANKJ Size---------------------------- Liqui4;.Depth -------------------------- <br /> -------------I------- <br /> S <br /> Capacit .- Type -------------------- Material---------------------- No. Compartments ------ --------- <br /> y ------nearest:to nearest. Well ----------------------------------..Foundation --_-------------____--'Prop. Line ----------- <br /> LEACHING LINE No. of Lines ------------------------- Length of each line---------------------------- Total Length .-------- ------------------- <br /> 'D' Box ------------- Type Filter Material ____________________Depth Filter Material -------------------------------------------- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property,Line --------- -------------- <br /> SEEPAGE PIT Depth --------- ---------- Diameter ---------------- Number ------- - ------------------ Rock Filled Yes ❑ No <br /> Water -Table lDepth ------------------------------------------------Rock,Size -------------------------------- <br /> f <br /> -j—.Di stance,to nearest:Well --------------*------------------ -__--Foundation -------------------- Prop. --------------------- <br /> ---------------------- Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit#`-------------------------------------------- Date _____________-_.____-____-____-___ tF <br /> I 1 Tank (Specify Requirements) ------------ <br /> -------------- --- <br /> --------------- ---------------------- <br /> --------4--------- i) <br /> Disposal Field (Specify Requirements) --- <br /> 1�5�-------------------------------------------------------------------------- <br /> ------------------- - <br /> --------- ------------------- ---------------------------------------------------------w--------------------------------------------------------------------------- ----------------- <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 Son 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 inf the performance of the work for which this permit is is-sued, I shall not employ any person in such manner <br /> as to become subject to Workman's Comperi'Sation laws of California." <br /> Sign r <br /> -- ---------- wne <br /> ------------ -------------- ---- ---------- <br /> Byitle ---- -- . . ... .............................................. .... <br /> 11f other <br /> Cl,1FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- - . __1,- <br /> __W------------------------- --------------------------------------------------------- -------- DATE -7- <br /> ------------- <br /> BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE ------------------------------------- ----- <br /> ADDITIONAL COMMENTS -------------------------------- 6-1 <br /> --- ----- <br /> - <br /> ------------------------------------------------------ <br /> -------------------- <br /> -------------------1P_J------ ---------- -j- -6 ----------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------ <br /> Final Inspection by. ------------------------------------------------------- --------------------------------.Date .te <br /> ---�k_ N-- ----------------------------------------------------------------- ----------- --------- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9' 1-'68 Rev. 5M <br />