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FOR OFFICE USE: <br /> APPLtCATIQN.FOR SANITATION PERMIT <br /> -------------- <br /> (Complete in Triplicate) Permit <br /> -------------------- <br /> - - --•---------------- This Permit Expires 1 Year From Date Issued Date Issued _. .-�a�-_'7-3 <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 /> JOB ADDRESS/LOCATION ..`�(� -:�'+ � ���- ����---__ _ ���ICENSUS TRACT .................... <br /> Owner's Name ------/__I` AoV----------- ----- . <br /> t�,� � ............. <br /> r --------------------------------------------------�_------------------Phone ------.....------------ <br /> Address __.. 9 T�r.�/�- p2-------------............. Cit <br /> Contractor's Name----- --__,_.License#cSr/_J3-- Phone '_ -Q� <br /> Installation will serve: Residencg Cpartment House Commerci I❑Trailer ourt 0 . <br /> Motel ❑Other-------yx,.p_ :_- <br /> Number of living units:_-- _-.----_ Number of bedrooms ..... •,� � <br /> : .-_-_Garbo Garbage -- Lot Size -:•` _____________________ <br /> Water Supply: Public System and name __________________ __ Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ ClayX Peat❑ Sandy Loam Clay Loam <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 p " Z\ <br /> [ ] SEPTIC TANK[ ] Z\ <br /> Capacity <br /> Liquid Depth -...:���__-_- <br /> Capacity ../_ o(? Type G -Material_._ 6x�_'.._. No. Compartments _._. <br /> Distance to nearest: Well -------Z:0©_--- __ ____-Foundation _/D._.7.-..__ Prop. Line _- 5_-___'_ ------ <br /> LEACHING LINE [] No. of Lines _-._/------------------ Length of each' line-__../c�C_)_----- <br /> Total Length <br /> 'D' Box <br /> .._ Type Filter Material _ - Depth Filter Material _._-- ......................... <br /> Distance to nearest: Well _.AQ-:C)----------- Foundation ..,lP- --------- Property Line -_- _. <br /> SEEPAGE PITDe th 4� Diameter �r <br /> [ 1 p ----`-T- ----- -- ��_..___ Number -----------I/------------- Rock Filled Yes No <br /> Water Table Depth ------- _---- <br /> -------- <br /> Rock Size - - -- <br /> Distance to nearest: Well ----- --_-----__________________Foundation ./D. -------- Prop. Line -. - <br /> REPAIR/ADDITION(Prev. Sanitation Permit#.....--------------_--__-----______-.---_..- Date _-_--_--_-------_--_----------.-•-) <br /> Septic Tank (Specify Requirements) ------ --------------------------------------­---------------------------------- <br /> Disposal Field (Specify Requirements) ____________________________________ <br /> -------------------------------------- ----------------------------------------------------------- ---------------------------------------------------­­--------------------------- <br /> (Draw <br /> ------ - • ------------------------- <br /> --------------------- <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 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 beco su lett to or an's ompe tion laws of California." <br /> Signed --------- G Owner <br /> By _- ------ - - Title ..------_------------- - - <br /> - --- ....... "1 <br /> (If other than ow er) �' <br /> OR .DEPA MENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -- ------- • ---- ----•---------------------------------- ----------------------- DATE ---- - --�-- _ •. <br /> '-- - <br /> BUILDING PERMIT ISSUED ------ - - ------ -- --• -------------------------------------------------------------- -------DATE ---------------•------------��---- <br /> ADDITIONAL COMMENTS __ 1..... ..... .. . <br /> - ---- ----- ----- ----------------------•-----•------•---•--- -•----• -------------------------------------------------------------•............ <br /> •----------------•- -- _ <br /> Final Inspection by: ----- - Dated <br /> - <br /> N JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 ev. 5M <br />