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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 7� � <br /> b y �l- c't } � Permit No: �'3 <br /> (C6%hplete<in 7riplicote) <br /> ---------- ------- -- --------------------------------- /7 <br /> 7 <br /> .._.________________________ .This Permit Expires i Year From Date Issued Date Issued ___._ <br /> Application is hereby made to the!San Joaquin Local Health District for a <br /> PP Y q 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 /> oo <br /> JOB ADDRESS/LOCATION7 <br /> . ! ------------------ -- -- ------CENSUS TRACT ------------------------- <br /> / " <br /> Owner's Name ' 'A-4 ,E� ------------------------------ -- -------------------Phone ------------- <br /> Address ---� ? ---------- Y <br /> Contractor's Name --- -, -- ---------------r __ ------------Lice Phone <br /> Installation will serve: Residence A Apartment House[] Commercial:❑Trailer Court i❑ <br /> Motel ❑ Other /____I------------------------- <br /> I _ _ _ _ _ . _ _ <br /> Number of living units:-----/___ Number of bedrooms ____T Garbage Grinder <br /> &V-- LotSize ---...------•-•----- <br /> Water Supply: Public System and name ---------------------- --------- �- ----- ------------ Private <br /> Character of soil to a depth of 3 feet: SandE] Silt E] Cla i' 0 Peat E] Sondy,Loam Q CAby Loom E]I Hardpan E] Adobe 4iII'Material ____________ If yes aype, _.._______________ <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 septictank or seepage pit permitted if public sewer-is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK'[ ] Size___--"____._._.._ ____________________ Liquid Depth _.__________________,_____ <br /> �+ <br /> Capacity ------------------ Type -------------------- Mateiial------------ ----------- <br /> No: Compartments ----------------- <br /> Distance to to nearest: Well ------------ -*'`+FF------------Foundation ---------------------- Prop. Line ......... ------------ <br /> LEACHING LINE [ ] No. of Lines ------------------------ Lengfih of peachline---_-----------------.------ Total Length ---------------------_---•- <br /> t <br /> 'D' Box -1--------- Type Filter Material ------- .----------Depth Filter Material -------------------------------------------- <br /> ^— Dista"nce to nearest: Well ------------j__�------- Foundation ________________________ Property Line _.__-___-_________._.... <br /> f i <br /> SEEPAGE PIT [ ,j Depth _____�______________ Diameter -------- Num, ber ---------------------------- Rock Filled Yes ❑ No <br /> Water Table Depth ------------------------i----------------------Rock Size -------------------------------- <br /> a{ DistanIce to;i nearest: Well ________________�_____ ________________Foundation -------------------- Prop. Line _-_-___-__-------__._-- <br /> It 1 .1 <br /> REPAIR/ADDITION(Prev.xs anitation Permit# --------_------------ __;---------------------- Date _____________________.____________) l <br /> T Irr,. <br /> Septic Tank (Specify Requirements} -----------•--------••------- ------------------- <br /> Disposal Field (Specify Requirements) - __ _.__.___ _- ---/ -_� � <br /> 1 � -- - <br /> ____ _____________________. Y --------------------�---------------.-------------------------------------•------------ 4 <br /> ---------------------------------------------------------- <br /> hereby cerci that I have prepared this <br /> --- it -- -- - --- e <br /> i '`existing and required addition on=reverse side) <br /> y fy p p 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!,9�, <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." a <br /> Signed ---- ------------------- -- ----------------- - ----- _ Owner. <br /> t � � <br /> By------------------------------- fitle(.x��� '� ' <br /> - ---------------------- <br /> (ff o e than owner} <br /> t ' <br /> FOR DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED BYJ <br /> ' = /- ---------------------------- - DATE J :` f <br /> BUILDING PERMIT ISSUED ----------- )= == DATE <br /> --------------------- - - <br /> ADDITIONALCOMMENTS 1 ------------------------- -------------------------------------------- ---------------------"---------------- <br /> ------------------------------------------------------------------- <br /> --------------------------- _--e- <br /> i <br /> a7 <br /> -g ---- -- ------------ ----- --- ---------- <br /> - <br /> Final Inspection b ' �� - <br /> P Y� ---------------------- ---- -- - ------------------ -- - - -- -._.�__.. -- � - - ---------------------.Date _..-- ---- - - -- -------------------- <br /> SAN JOAQ I LOCAL H ALTH DISTRICT <br /> ee <br /> E. H. 9 1-'68 Rev. 5M <br />