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FOR OFFICE USE: ' <br /> PLICATION FOR SANITATION PER* <br /> ............. i_ Z Zi <br /> '. ..---.:------ - (Complete in Triplicate) Permit No.7j <br /> . <br /> .........-- ------ This Permit Expires I Year From Date Issued Date Issued -6_----.. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. yisappl tios mad 'n compliance with_RW <br /> Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION //. ......-_ISy �_ ...4._.- S�j..-CENSUS TRACT _ _ .-..-_ <br /> Owner's Name .: / - '.. , Phone .....�h'rl- <br /> q• � may. _ - .... . ...... . ... - <br /> Address ----�/- .-.�.-., �1�1__----- .... - -------------------------. City - ------- ................................... <br /> Contractor's Name ..M—O �3- v^ ----License #� � .. �.7 Fhone <br /> Installation will serve: Residence oApartment House 0 Commercial ❑Trailer Court 0 <br /> Motel ❑Other...- =-=--------- --------.:-:_:_.:::----- /,y <br /> Number of living units:--,/!--.-. Number of bedrooms ..3..._.Garboge Grinder 1?:�Yu Lot Size ---.L L. ------------ -- <br /> Water Supply: Public System76nd name ._......•--......----- ......------ --- .... -------•----....... ............ .................Private <br /> Character of soil to a deptWof,3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam[] <br /> Hardpan ❑ Adobe X Fill Material -?V--- If yes,type ............................ <br /> (Plot plan, showing size of lot, location of system n relation to wells, buildings, etc. must be placed on reverse side.) �y <br /> NEW INSTALLATION: {No septic tank or seep a pit permitted if public sewer is available within 200 feet,) c <br /> PACKAGE TREATMENT [ I SEPTIC TANK[ Size------ -..---___ Liquid Depth ----ME <br /> /No. <br /> pacity -Lr P-a..__--. Type P ° 1r-- Material...6.cwr.�t-rkd% No. Compartments ._..-1. <br /> tance to nearest: Well ----....r-0....................Foundation _..._/...d........... Prop. Line .._S7....._..._. <br /> LEACHING LINE of Lines ..�.............. Length of each line------7'>.:.............. Tofal`Length ... -..._.._.__ <br /> 'D' Box '1JR.e.... Type Filter Material ...j..f?----------Depth Filter Material' -.-.--__1r............................ <br /> Distance to nearest: Well ......�'T. L.......... Foundation .Ln................ Property Line ........5------- <br /> SEEPAGE PIT Depth --l.y ... Diameter ..____�..... Number -------------- ...... Rock Fil ed Yes $f No 0 <br /> Water Table Depth --------- ...- ✓---------------------Rock Size ---- <br /> Distance <br /> --Distance to nearest: Well ......... ......................Foundation .......... Prop. Line ...s ............ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ............ ------_--.._---) <br /> Septic Tank (Specify Requirements) -------- ........................... <br /> Disposal Field (Specify Requirements) --------------- -------------........---------------------------- --------- ............................ ................--- <br /> ....................................................................--------------------------------..................... . --------------.....•••••-------.....I- -_---------------- <br /> _ ___ __ ____...................... ......... ...... ------------- ----------------------- ------ - -----------............................................ <br /> (Draw existing and required addition on reverse side) <br /> f 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 --------......-------- ............................... Owner <br /> By --- .` ..------......-......------......- -----• Title ----------....-----------------------------------------------...... <br /> (I other than wrier) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --T.R_-Q'................................................------•.-.------.----.._--. DATE ..... <br /> BUILDINGPERMIT ISSUED .................. ........................................... ............................... ------...DATE . ............... ----------------------- <br /> ADDITIONAL COMMENTS ... - .... ---.... ... ... .................... .........•--............ ••-----------.......................--- ---- <br /> --------------------- - - ..................................._ ............ .............. .... ....... --- . ... ........ .. <br /> Final lnspedion R <br /> .. .-_. - ............................._Date --.�...�-.�.... ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1•'68 Rev. 5M <br />