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Y y <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ------------------------ - --------;­­-- ---- Permit No. 7/--` <br /> u, (Complete in Triplicate) <br /> __________------------------------------------ This Permit Expires 1 'Year From Date Issued Date Issued <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 compliances with County Ordinance NNo_. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION - - _ G-_c CENSUS TRACT <br /> Owner's Name --------------- - ------- ----• -- - ----------------= ---------Phone <br /> Address ------� ------------ City -------------------------------------------- <br /> r <br /> Phone �_/ 3p = <br /> Contractor's Name -------- ��� ------ <br /> ��-------- ------License #���/�-r�- �` <br /> Installation will serve: Residence 'Apartmen't Housa',❑ Commercial;❑Trailer Court, 0 <br /> t. T � <br /> Motel E] Other -------------------------------------------- ,. <br /> Number of living units:___1___ Number of bedrooms—:%?'___Garbage Grinder "`d _ Lot Size --.......0------_---I-/-e...... <br /> Water Supply: Public System and name'_' =------------------------------------:-----------------------------•---------Private ❑ <br /> Character of soil to cr depth of 3 feet: Sand'Q Silt❑ Clay ElPeat❑ San y Loam -El Clay Loam El <br /> iHardpan ❑ Adobe �k Fill Material ------------ If yes,type -------------------------- - <br /> . s <br /> {Plot plan, showing size of lot,11pication of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No sept.ictank or seepage pit permittedif p ublic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANKSize__ lX-S-----, /al______ Liquid Depth ____ _____..____ <br /> Capacity1,e.-_C4.1_•Type _ Material_ No. Compartments ---2______________ <br /> Distance to nearest: Well ------ 'r---'__------------Foundation ___/11 ----- Prop. Line ------------ <br /> LEACHING <br /> ____-------"-LEACHING LINE No. of Lines ___- _______________ Length of each line..___._e_?r--r-------- Total Length :.� ----------- <br /> y,"D' Box . ----- Type Filter Material Depth Filter Material ____ 9__`+_r______________________ <br /> Distance�to nearest: Well Q-_`--------- Foundation - -------------- Property Line. � <br /> SEEPAGE PIT kr " Depth C f------ Diameter _,U-------- Number ______4 27__________________Rock Filled Yes " No �❑ <br /> Water Table Depth ------9.47--------------------------- <br /> ----Rock Size --- --------------------- <br /> - ---- -- <br /> f --- , <br /> ' Distance to nearest: Well -------------------------Foundation ___`®`__:____ Prop. Line _'__ _______._________ <br /> REPAIR/ADDITION(Prev. Sanitatio Permit#__-----------------------------------------Date ---------------------.-------""_"-I <br /> Septic Tank (Specify Requiremdnts) -------- ----------------------------- ----------------------'=--- --- <br /> Disposal Field (Specify Requirements) -----_-_____ ----------------------------- <br /> ------- -- -------------- --- <br /> --------------- ------------------------------------------------- ------------------------------- t <br /> - --------------------------------------------- <br /> I ► (Draw existing and required addition on reverse`side) <br /> I hereby certify that I haveprepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws,avid 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 L employ any person in such manner <br /> as to become sub'ect,to.Workman s Com pensdtion.laWs of California." <br /> Signed -- ------ ------- --- ------------- -- --------------------- Owner i. <br /> BY -------------- -------------- Title ----- - --- ------------------- <br /> (If other than ownerl <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY 77P-4 --- / C1 f -------=--------------------------------- DATE !-- --- <br /> BUILDINGPERMIT ISSUED --------------------------------------------- ---- ------------ ----------------------------------DATE -- ----- -----------------------------••--- <br /> ADDITIONAL COMMENTS ------------------#---------------------------------------------...----------------------------------------- i <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> i _ : <br />' ----------------------------- -- ------- -- --- --------- ----- --------- <br /> ----- <br /> -------------------------------------------- <br /> Final Inspection by. = -------`------- --------------------.Date --- - -- '. � <br /> 71 <br /> SAN JOA UIN LOCAL HEALTH DISTRICT <br /> E. H. 9 7-'6$ Rev. 5M <br />