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APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />Phone <br /> City <br />Contractor's Name License # . . <br />Water Supply: Public System and name <br />. Garbage Grinder/ Lot Size ‘C-121--- 3 <br /> Privoie_43 <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS <br />_ FOR DEPARTMENT USE ONLY <br />.-•-if,,2")7...‹.:4•Ait DATE 7 <br />-7 <br />DATE <br />Final Inspection by <br />Permit No. 7.‘) — <br />Date Issued . <br />Application is hereby made the San Joaquin Local Health District for a permit to construct and install the work herein <br />described. Thi‘appli tio madeen compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />Owner's Name <br />Installation will serve: <br />Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loam 0 Clay Loam <br />Hardpan JZ Adobe 1:1 Fill Material If es, type <br />mar- <br />"1— <br />Foundation <br />LEACHING LINE Al No. of Lines ok2... .. .. ... Length of each line ..4).-1? ... <br />'D Box ?//iii-P. Type Filter Material /7'.- Depth Filter <br />/ <br />Distance to nearest: Well ..../iTP '... .... Foundation / 0.- <br />SEEPAGE PIT ()A Depth /2- 3.- . . Diameter 3 '' Number ... <br />Water Table Depth ?c, • <br />Distance to nearest: Well / a.7.-P Foundation <br />REPAIR/ADDITION (Prey. Sanitation Permit # Date <br />Septic Tank (Specify Requirements) . . <br />Disposal Field (Specify Requirements) ........ ........ - PER":7— 4 PPL1-. <br />FOR 3 13FDROOr," wgz-44 Ar(7- <br />-r. <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 is issued, I shall not employ any person in such manner <br />of California." <br />{if other than owner1 <br />- <br />JOB ADDRESS/LOCATION 1 2ENSUS TRACT ti 4/7 <br />Phone t 77 ..... <br />Number of living units: . <br />Residence ci) Apartment House 0 Commercial [Trailer Court 0 <br />Mote/ D Other <br />Number of bedrooms <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) <br />NEW INSTALLATION: No septic tank or seepage pit permitted if public sewer is available within 200 feet,l <br />PACKAGE TREATMENT SEPTIC TANK <br />../ <br />-4/ <br />Capacity ..6-7) <br />Distance to nearest. Well <br />Size gt-t- 4? Liquid Depth <br />Type 6'1"..... No. Cier.-14',.1..4,2 No. Compartments <br />Prop. Line rd' <br />Total Length <br />Material <br />Property Line -•.:5 <br />Rock Filled Yes Cfr <br />Rock Size / •,'"'";;.-,e <br />//0 Prop. Line <br />No 0 <br />as to boco ject toWorkman's Compensation laws <br />Signed <br />By <br />Owner <br />. Title <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 1-'68 Rev. 5M <br />FOR rDFFICE USE: