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FOR OFFICE USE: <br /> ' '" APPLICATION FOR SANITATION PERMIT - <br /> (Complete In Triplicate) <br /> ",Z&e it No. ... ... ...... <br /> ..... ........................... „rpt <br /> ......................... .............................. This Permit Expires 1 Year From bate Issued �� Dote 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 /> tj <br /> JOB ADDRESS/LOCATION .:..........."7ZL�.TS .................. <br /> CENSUS TRACT <br /> Owner's Name;�...................A0.0... <br /> '� �. Phone . ..-L�?!5..:.... <br /> Address ..... .... ....... '� c <br /> ..........._ <br /> ----•-..._._ � ...... city S�e1c <br /> i Contractor's Name .._... n ...._..... <br /> F ,.I'i_ ... 1�2�2-!s.t!�.. _�x`t, .� `� License # `{3 .._.:. Phone . $'`�. 4 <br /> .............. <br /> Installation will serve: Residence Apartment House Commercial oTraller Court ] <br /> �. <br /> Motel ❑Other _.. •............... ..:__ ; <br /> Number of living units::---t%.__. Number of bedrooms ..a7.'.-------Garbage 'Grinder .........._. Lot Size 1'f'r <br /> Water Spply;'Public Sys#em'and name ................. y <br /> -----•..._----------------.................................__... _..........._..._.......Private ❑ <br /> I Ch&acterrof soil:fo a depth of 3 feet: Sand Sllt- Clay { <br /> i ❑ ❑ y ❑ Pe at QSandy Loam Clay Loam Q \ <br /> H rdpan Q Adobe Fill Maferkial ._--_-VC]_ If yes, <br /> type --------------------------- <br /> Mr+a-ri� #0. Ji..(:?i 1 f I <br /> (Plot pl n, showitg size of lot, location of. system in to}weiis� t <br /> t r buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: A . <br /> * . F { o s P c tack or seepage pisp %jtted If public sewer;is available within 200 feet,) <br /> I i;PAC-KA&E TREATMENT,–[ I IEPTIC TANK <br /> t Size. ------------------------------- Liquid Depth <br /> r Capacity _____________ Type ..... Material... No. Compartments <br /> T e ............... <br /> i - <br /> Distance to nearest: Well ..........Foundation <br /> [`ACHING LINE I[ j - <br /> i No.Boof Lines----- Type Filter Material .............. ....Depth. Nlaterialal Length f._.-;• <br /> . r — Length of each line.--------_- --®:-- - ......... <br /> g <br /> '. .. <br /> 1Mier <br /> Distance to nearest: Well ............ ........... Foun ation -------------- --------- Property Line <br /> I <br /> SEEPAGE PIT [ j Depth ........ -Diameter ................ Nuber ...... Rock Filled Yes ❑ No [1 <br /> h <br /> Water Table Dept <br /> ...............-................................Rack Size ......................... <br /> Distance to nearest: Well .....•-----.-- Foundation ............. <br /> .... . ----_ Prop. Line <br /> REPAIR/ADDITION{Pr -Sanitation Permit # ••-----•._...----------•_......•-------..Date t <br /> _ ., <br /> ic an (Specify Requirements) _._..... �!.0:�1 <br /> . ............................... <br /> ....... <br /> _...__.... <br /> Disposal Field (Specify Requirements) ............ <br /> --------------- ---------------••- ----------••......•••--- ...... -- <br /> .----..---- ' <br /> ' <br /> ------I--------- --------------- <br /> ---------•---------------••------------•--............................................................ <br /> {�__- i (Draw existing and required addition on reverse side) 1 <br /> I thereby 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.5an Joaquin Local Health District. home owner or licen- <br /> sed`agents signature;ertifies 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 Wer man's Compensation laws of California." <br /> Signed __...._..-- - --_ Owner <br /> By ---••-.._.--... -• i <br /> - ------.....• --..... Title .a..:....................... ...........If than owner) -•'---------• <br /> F R EPARTMENT USE ONLY <br /> . .... ........................... <br /> _ <br /> APPLICATION ACCEPTED BY7 . ...... -•. ._ :. . .- <br /> DATE ... 7 <br /> ... ... .. _.._. _.. _ <br /> BUILDING PERMIT ISSUED .._ • . _--=-------_-...DATE .......... <br /> ADDITIONAL COMMENTS ..... <br /> .............................................•...•--'..........................------------------•••- -------------• - ---.._..._-••••--•-•-••-• ------....................................... 3 <br /> -------------------------------••-- ------...... ................................................................. ................ <br /> FinalInspection by ate .......... ••------•--- <br /> ..-•---•......•----•----•••-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> .. E. H.13 241-'68 Rev. 5M <br />