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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 <br /> Permit Na: ._-.-_"-`------•--- <br /> (Complete in Triplicate) <br /> ----------I--------------­ ----------- --------------- Date Issued �=a�-•=-�� <br /> _ __ This Permit Expires 1 Year From Date Issued <br /> --------- .- q ' <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 /> g' Ci: TRACT <br /> CENSUS <br /> SCS � - --�- ---�-�;- "�.:� � � _ _ _ <br /> JOB ADDRESS/LOC TION .------------------------------ _ <br /> �,T4 : <br /> --_` _ _,R�... .-..m "--.---. -"-.._ Phone _----------------------- <br /> -----_------ __-_----_••---_ <br /> _Owner's`Name ----- ._ <br /> 1 <br /> -- city - <br /> Address ------ -�" 4. <br /> _=.- <br /> _ f ���7r P ne ------------------------------ <br /> Contractor's <br /> -------- ------------------- <br /> Installat on will serve: Residence Apartment House�El Commercial ;[]Trailer Court ;❑ <br /> Motel ❑ Other ------------------------------------------- <br /> Number of living units-------I---- Number of bedrooms �-----Garbage Grinder ------- Lot Size _�--------------�-. <br /> Water Supply: Public System and name ----------------------•- ------------------- --"--- <br /> Character of,soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> 4 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 /> :., ty V\ <br /> I PACKAGE TREATMENT { ] SEPTIC TANK'[ 7 Sliize-----------------------------=°----------------- Liquid .Depth - --------------•-•- Q <br /> I <br /> Capacity ------- - ----- --- Type ---------- --------- Material------------ --------- No. Compartments <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -_--------------•- - <br /> LEACHING LINE [ ) <br /> No. of Lines --------------------- -- Length of each line---------- ----- Total Length ----------2� <br /> Box ----------- - Type Filter Material _____"-__----__ _Depth Filter Material ---------------__-_.--------------------•-- <br /> Pro er Line. ------------------ <br /> Distance to nearest: Well ------------------------ Foundation -__------------.- ---- Property I <br /> f SEEPAGE PIT [ ) Depth ---------------- Diameter ---------------- Number Rock Filled Yes E:1 No <br /> Water Table Depth -- ----------------- --Rock Size ------------ ----- •---- ii <br /> I Distance to nearest: Well ----------------------------------- ---Foundation -------------------- Prop. Line ---- -'---•------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- { <br /> Date ----------------------------------) <br /> Septic Tank (Specify Requirements) -------------------- -------------------------------------------- <br /> = ----.---------------------------- <br /> �.� <br /> Disposal Field (Sp cify Requirgments) ------------------------------------- f <br /> p <br /> ---------- <br /> -------- - - <br /> 0. 3 <br /> F <br /> ( aw existing and required ad <br /> : - - --- - --- ---- ---- ----------- / . <br /> - s g q clition an reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance w,ith'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 /> i <br /> Signed Owner <br /> - ------------------ <br /> Title -------- --- y <br /> By <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY w�v <br /> APPLICATION ACCEPTED BY -.- "_ DATE -Q----�l-- �J----------- <br /> I ----------, <br /> - - - - - --------=--- ---------DATE ----------- ------°----------------------- <br /> BUILDING <br /> - --------- -------- <br /> BUILDINGPERMIT ISSUED ------------------------------------------------------------------ ----- <br /> ADDITIONALCOMMENTS -------- ----------------------------------------------------------------------- --------------------------------------- <br /> ------------------------------- <br /> ------------ ------------------------- _ _ _ <br /> --------------------- `---------------•----- ----------------------------------- --------- --------- <br /> --------------------------------- -------- -------- --------- .---- --- ---- ------------------------ --------------- <br /> = ----- ------- <br /> ---- -------------- ----- Date <br /> Final Inspection by: -- ----- _ AA"'-------------------- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />