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APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />Permit No. <br />Dote Issued <br />FOR OFFICE USE: <br />- y V, - • .............. <br />JOB ADDRESS/LOC ;\,1- -4? <br />Owner's Name <br />Adciress <br />Contractor s Name . <br />•••••••• <br /> <br />Az-per' <br /> <br />... <br /> <br />Final Inspection by; <br /> <br />Application is hereby mode 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 />CENSUS TRACT S 6 -••••-•••• •••••••.- •••• <br />Phone <br />City kaetetor..., <br />License #adlrait73-4V" Phone <br />Installation will serve: Residence Apartment Houser". Commercial 0Trailer Court 0 <br />Motel E Other <br />Number of living units: .,. .. Number of bedrooms .r:›1:- Garbage Grinder Lot Size <br />Water Supply: Public System and name - Private <br />Cnarocter of soil to a depth of 3 feet: Sand 0 0 !Clay ri .Peat E Sandy Loam 0 Clay Loam 0 <br />' Hardpan ;_, • Adobe 0 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 />f , . <br />NEW INSTALLATION: 1(No septic tank or seepage pit permitted if public sewer is available within 200 feet.) <br />PACKAGE TREATMENT J 3 SEPTIC TANK I 3 2 iSie .• .. - — Liquid Depth <br />Capacity Type ...,........2.... ...... Material ..........__ No, Compartments ... ..,-- . .. ... ..... ‘..) , i I . <br />-, ;.; <br />Distance to -nearest -Well _____1... s _ Foundation . . Prop Line <br />: <br />' EACHING LINE [ No. of Lines . , Length of each line Total Length <br />..- . . .. . , <br />'0*—Box ......_. Type Filter Material Depth Filter Material .„. .... . ........ ._ ............ ...... NI <br />, __ _ . <br />Distance to nearest: Well ' Foundation Property Line . .. ..... .... <br />. , . <br />SEEPAGE PIT Depth ... ...„ ..... . Diameter ....N urnioe7 —Rock Filled Yes 0 No 0 , <br />Water Table Depth . . Rock Size " <br />Distance to nearest: Well ...„.... -,..--- Foundation .................Prop.Line <br />REPAIR/ADDITION (Prey. Sanitation Permit # . Date . —.1 <br />, <br />Septic Tank (Specify Requirements) ........... <br /> <br />Disposal Field (Specify Requirements) . /47 0' j,..."--4124teet oe .../ <br />33 I i X )--'17 . — ... ... ..-- <br />(Draw existing and required addition on reverse side) <br />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 become subject to Workman's Compensation laws of California." <br />Signed Owner <br /> <br />By . ... <br />(If other than owner) <br /> <br />.. <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED <br />\DDITIONAL COMMENTS <br />DATE A - .... <br />DATE •.•_ ... .. <br />.... . ..... ............ .............. ... - • <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 1-'68 Rev. 5M