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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No-. 7a-&_71_ <br /> (Complete in Triplicate) <br /> -------- <br /> -- --- -------- Date Issd <br /> ------------------ e --- <br /> This <br /> Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Sa Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made i compliance with County Ordinance No. 549 and existing Rules and Regulations: } <br /> JOB ADDRESS/LOCATION .--- -rJO r---!'----------- ---- ------------ -------------------- ---TCENSUS TRACT -- ----- --- ----------- <br /> Owner's Name N ---- •------------------ Phone <br /> Address ----------- ---------------------------------------=------------------------------------ ------------ City <br /> Contractor's Name _ ®'lC ..�- License # Phone <br /> Installation will serve: tesidence FiiKpartment House❑ Commercial:❑Trailer Court ',❑ <br /> Motel ❑Other ---- <br /> Number of living units:-..-)------ Number of bedrooms __Garbage Grinder -----------!1 Lot Size --- ------ -----------• <br /> Water Supply: Public System and name -___-___-----__-_ - ✓�'� - Private <br /> Character of soil to a depth of 3 feet: Sand' Silt❑' Clay ❑ Peat ❑> Sandy Loam ❑ Clay Loam ❑ <br /> } <br /> Hardpan ❑ Adobe-'❑ "Fifa Material" ' if yes,type ----------------"----------- <br /> (Plot plan, showing size of lot, location. oftsystem `intrelotion=to-well`s, 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 /> Sze t3----------------- <br /> y+` i------------sr---'<.--quid Depth ------ d <br /> PACKAGE TREATMENT SEPTIC TANK S i _h <br /> Capacity ----------- -------- Type ----------------- Md�ERZil : ' No. Compartments <br /> Distance to nearest: Well ------------------------------------Foundation _"-_---_--__--___ Prop. Line _-_---__.-.___-_-_---- <br /> s- --- .- -- <br /> LEACHING LINE F ] No. of Lines ___-.------------------ Length of each line----------_--.--- ---. Total Length ------- <br /> -------•--•-•-- <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------- ---------------- ---- <br /> I <br /> Distance to nearest: Well ------------------------ Foundation -_---------- -------- Property Line - - _-------_.--•--- <br /> SEEPAGE PIT [ ] Depth ----------------""-- Diameter --------------- Number "----_._____---.- ------ Rock Filled Yes C] No ❑ <br /> _ ' <br /> WaterTable Depth --------------------------------------- -------Rock Size --------------------------------- <br /> Distance <br /> ----- _----"-------------- 4 <br /> I <br /> Distance to nearest: Well ------------- ------------------k-------Foundation ----- -------------- Prop. Line-------._--_-_-_-__-- <br /> REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------- ---- Date ---------------=-;----------------} <br /> Septic Tank (Specify Require ments) ------- <br /> Disposal Field (Specify Requirements) ---_ --- ' k <br /> i <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 isoissued, I shall notpmploy any person in such manner <br /> as to become,subject to Workman's C mpensati.on laws of California!' <br /> s Signed-- - - `` -- ----------------- ------------ Owner <br /> i , ---- ------------------------------------------------ <br /> --------------- ----------- Title <br /> (If other than owner) } <br /> FOR DEPARTMENT USE; ONLY <br /> APPLICATION ACCEPTED BY1-------- DATE --- fid -7 -J------------- <br /> BUILDINGPERMIT ISSUED ----1--- --------------------------- ---------------------------- --'-----------------------------------DATE ----------------------------------------- <br /> ADDITIONAL COMMENTS ------ <br /> `____." �"" `- ��"�"`"`"�" —� <br /> _-_-_.__- ----- -------------------------------- ------------------------- ------------------------------- ---------------------------------------------- <br /> ---------------------------------------------- -- ---- - <br /> -------- <br /> P Y- ---------- <br /> ----------------------Date 3 <br /> Final Inspection b -- ---- ---------- ---------------------- --- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br />( F. H. 9 1-'68 Rev. 5M <br />