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<br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires Year From Date issued <br /> <br /> <br />Permit No. 7 - <br />Date Issued .. f -,z 4 --- <br /> <br />ascribed. This application is mode in compliance with County Ordinance No.. 549 and existing Rules and Regulations: <br />oplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br />02 51/420 71 CENSUS TRACT <br /> Phone <br />IMMO <br />City <br />ece) License # 43ff2J Phone <br />Residence Apartment House° Commercial °Trailer Court 0 <br />Motel 0 Other <br />Number of living unit s2 Number of bedrooms Garbage Grinder <br />Water Supply: Public System and name <br />Character of soil to .a depth of 3 feet: Sand it ID Clay 0 Peat CI SOnclY Wrn 1:3 Loam <br />Hardpan Adobe 1:1 Fill M'aterial if yes, type <br />(Plot pion, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse <br />NEW INSTALLATION: (No septic tank or seepage pit permitted if 9ubIIc sewer is available within 200 feet) <br />PACKAGE TREATMENT [ 1 SEPTIC TANK Sizo /..er 9 `,.r....--5--' Liquid Depth '; <br />Capacity 1 04f, Type --0-a- Material. .e-..:c._. No. Compartments-,V---- <br />Foundation - -Za-, Prop. Line .......5" ..... y Distance to nearest: Well lz.7. <br />LEACHING LINE 1/ No. of Lines 3 Length of each line VJC?.././7.7. .... Total Length ..../...-.-1. <br />'0' Box ,/ Type Filter Material ,54 Depth Filter Material <br /> <br />/ <br />Distance to nearest: Well . <br />SEEPAGE PIT [11 <br />.g. ion <br />Depth ..4;Z. --5— Diameter ... <br />,..3.3 ,,, Foundation /. if:? Property Line <br /> Rock Filled Yes IBNó a <br />Water Table Depth it) 6 A,-/- Rock Sire i../A-.1'.4/.3 .e./ <br />Distance to nearest: Well ...... 4.0.4 Foundation /..a. Prop. Lino <br />REPAIR/ADDITION (Prey. Sanitation Permit # Date i <br /> <br />Septic Tank (Specify Requirements) <br />Disposal Field (Specify Requirements) <br />(Draw existing and required addition on reverse sidel • <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 flealth..District. Home owner or licea. <br />sod agents signature certifies the following: <br />"I certify that in the performance of the work for which this permit Is Issued t shall not employ any person In such manner <br />as to become sublect to Workmctre Compensation laws of California," <br />Signed I. Owner <br />By <br /> <br /> Title <br /> <br />(If other than owner <br /> <br />DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY <br /> <br />BUILDING PERMIT ISSUED DATE <br /> <br />NTIONAL COMMENTS <br />Contractor's Name <br />Installation will serve: <br />JOB ADDRESS/LOCATION <br />Owner's Name <br />Address <br />Let size ./e-7 <br /> Private <br />Clay Loam <br />DATE - <br /> kt== <br />Final Inspection by: .4q52.e Date Elf 13 2)4 1-68 Rev. 9,1 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 314