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FOR OFFICE USE: APPLICATION FOR'SANITATION PERMIT Permit No,. <br /> 4 --- <br /> ------ ---------;W96--- ---- <br /> (Complete in Triplicate) <br /> 0 <br /> ----------------------------- --- Date Issued <br /> df In <br /> Datetssued -. <br /> - --- ---------- <br /> ------------------------------------- <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 will C8,unty rdincince No. 549 and existing Rules and Regulations. <br /> ----------------CENSUS TRACT ._.__�: -------- ---------- <br /> # <br /> JOB ADDRESS/LOCATION <br /> 1141tV�_ r I I I-phone <br /> Owner's Name - --- --- --- ----- - -- -- -- ---- <br /> City ---------------------------- ------------ <br /> ------------------------------------ <br /> --- - -- ,---------------------•-..- ----------------------- <br /> Address -- ------ ---- Z <br /> -------------1 .1 IN - -------!.License #---- -- ---- -- --- Phone <br /> Contractor's Name ------ ----- - <br /> t <br /> Court <br /> Installation will serve, Residence El Apartment Housef]�Commercial-,QTrailer <br /> ----------I Motel ------------- <br /> E],.Other I------------------- I <br /> I ---- Lo Size X 42------------------- <br /> Number of living u its-1---- Number of 0droorn'll.e--- __-_Garbage Grinder <br /> Water Supply-. Public System and name ---------1--------------------"'.. M------ ------------Private E] J <br /> I I ' -s � Sandy Loom Clay-Loam .'E] <br /> Character of soil to a depth of 3 feet-. Sand'ESilt"IS] Clay EJ Peat-0 <br /> \If yes,type --------------------------- <br /> Hcirdpan E] Adobe Material <br /> (Plot plan, showing size of lot, location of systeVinelation to wells, buildings, etc. must, be placed on reverse side.) <br /> ewer is available ithin 200 feet,}NEW INSTALLATION: (No septic tank or seepage pit,,permitteldjf public s VY <br /> ------- I Liquid Depth ------------------- <br /> PACKAGE TREATMENT SEPTIC TANK-1 lj:� wSize----------------------------- <br /> ?q ------ Material---------------------- No. Compartments ------------- -------- <br /> Capacity -------------------- yp <br /> Distance to nearest:.-Well— <br /> Foundation ------------ --------- Prop. Line --------- <br /> 'to] Length ----------- ................ <br /> No. ofAines ------------------------ Length of each line--------------------- ------ To Is <br /> LEACHING LINEt <br /> -D' Box ------------ YPPsA;T Fitekr MciltiC_014-------------------Depth Filter Material ------------------------------ <br /> V ----------- Property Line. -------------­----I <br /> istance to nearest-. Well -----------1 --------- Foundation ------- ------ <br /> 1 Diameter __11 Yes C] No .0 <br /> SEEPAGE PIT Depth ------------------ - ------------ Number ---------------------------- ,Rock Filled <br /> I <br /> Water Table Depth ----------------------------------------I-------Rock Size ------------------------- - <br /> { <br /> qFoundation -- Prop. Line ---------------- ----- <br /> D :Jr - - <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------- ----------- <br /> Date ---------------------------------- <br /> Septic Tank (Specify R quirementsl --------------------------- ---- --- ----------- ---------- - ---- <br /> - --- ----- <br /> Disposal Field (SpecifyRequirements) f <br /> --------------- <br /> ------------ ----------------------------- <br /> -------------------------------- <br /> - <br /> --------- --------- --------------------- -- ------------------------------------------------------------------------------- <br /> -------- ---- -- <br /> -----------------------------------------------------------(-Draw-exi-st-i-ng,an required addition on reverse side) <br /> I ? <br /> I hereby certify that I have prepared this :cipplicati on.and-th.cit-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 /> Owner <br /> Signed --- ------------ --------------------- - ___�-------- <br /> Zt ------ ----------- Title -------------------- -- <br /> � <br /> - --------------------------- <br /> By --------�7----- --- - -- ----------- - --- ------- <br /> ----- <br /> - <br /> --- <br /> -------- <br /> (if of ertha ned OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ZDATE -- 7 - <br /> _ - --- -- <br /> BUILDING PERMIT ISSUED ------- -- DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS ---------------------- - ---------------- - ---------i---------------------------------------------------------------------------------- <br /> - <br /> ---------------------------------------------------------------------------------:--------------------------------------------------------- --------------------------------------- <br /> ---------------------------- ----------------------------------------------------------------------------------------------------------------I ----- --/---- <br /> --- - ----------- <br /> Fina - --------------------------DISTRICT <br /> SAN LOCAL HEALTH <br /> -------------- ---------------- ------�k------- --- - --------------------------------------Date----- <br /> I Inspection by. z-ze <br /> SAN JO U <br /> /4 <br /> E. H. 9 1-'68 Rev. 5M <br />