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FORN:ffICE USE: APPLICATION FOR SANITATION PERMIT ` <br /> Permit No. .. _ <br /> (Complete in Triplicate) 7 <br /> _TL< This Permit Expires 1 Year From Date Issued Issued . <br /> d - . -. <br /> plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> ,scribed. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESSAOCATION ��/ S SSS s, �r....��-.— /`1�I� CENSUS TRACT <br /> ............. <br /> Owner's Name __. .0 ,/ <br /> Pftone f. v. - <br /> - // . _ <br /> Address <br /> Contractor's Name .......................•............... ....................--•................... license # ................. Phone .............................. <br /> Installation will serves Residence partment House❑ Commercial C]Trailer Court ❑ <br /> Motel ❑Other ......... _... ... .... ........ /J <br /> Number of living units: Number of bedrooms .J,.....Garbage Grinder Lot Size <br /> Water Supply: Public System and name __. ......... _..._....... .......................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand Silt[] Clby rJ Peat❑ Sandy Loom ❑ Cloy loom (j <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 ( ) SEPTIC TANK ( ) Size ,.. _- Liquid Depth . . ................. <br /> Capacity ._................ Type .. . . ..... Material..... .. No. Compartments ........... S <br /> Distance to nearest: Well ._._._....._....................Foundation _ Prop. Line ._...._..........— %n <br /> LEACHING LINE ; ) No, of lines - Length of each line Total Length 1J7 <br /> 'D' Box Type Filter Material . ..................Depth Filter Material ...•.........., ......................_... <br /> Distance to nearest: Well .................... Foundation Property line --_------•-.---_--•_.-. <br /> SEEPAGE PIT ( 1 Depth Diameter Number ............. Rock Filled Yes ❑ No I_J <br /> C <br /> Water Table Depth _ ........................................Rock Size .......__.. ... ........__.. V <br /> Distance to nearest: Well ..................................._.Foundation .................... Prop. line <br /> REPAIVADDITION(Prev. Sanitation Permit# ........ ... . ... ...J.__ _.._...-. Date __. _ ............... ....1 <br /> Septic Tank (Specify Requirements) - -4--- .•-.......or <br /> ..F�. _ ...... . ..... <br /> Disposal Field (Specify Requirements) ��N�..�....'7�!......... .....v. ........... <br /> .................................................................................................................................... ..........T_r. .... -t ...._................................ <br /> ................ .......... .............................................................................. <br /> ........ <br /> fDrow 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. Horne 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 b�ee sub act o orkman's Com snsation laws of California." <br /> Signe ._._...._.. Owner <br /> By ............... ....._. ............................ Title .................................................................... <br /> . <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... .....t.......- - -------- - ------- . . .. --- _- DATE .... ........ ....-- --. . ._. <br /> BUILDING PERMIT ISSUED ..........................DATE ........----------.__.....------- <br /> . <br /> )DITIONAL COMMENTS ...... ......... ............ .......... <br /> ----------------- <br /> ... ........ <br /> ......-_...-....... ...r .. .. .... ....................._..........._. .. _ <br /> -- .. ._' . .... .. .................. ..__ - ... <br /> Final Inspection , .. d.... .. _ Dat! <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1•'68 Rev. 5M <br />