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FOR OFFICE USE: ltd APPLICATION FOR SANITATION PERMIT <br /> --75f/ <br /> Permit No. _.--" ----- <br /> ----------------------- {Complete in Triplicate} <br /> ------------------------------------------------- --- -- Date Issued _�'�:-�.� <br /> ----------------------------------------------------- <br /> -- This Permit Expires 1 Year From bate Issue - <br /> l the work <br /> Application is hereby made to the San Joaquin Local Health District nan a No 549 and existing Rulesrmit to construct and tand Regulations:rein <br /> described. This application is made in compliance with County 5,4 <br /> 3 �. 7' _ <br /> `� 3 �. � -{ iu -- / i CENSUS TRACT <br /> JOB ADDRESS/LOCA <br /> ._-� -W <br /> Owner's Name -- ----- Phane <br /> > Jl._tY- � f� -------------------------------------=- --- --- <br /> -- -.�` n-Q�_ --------- -- <br /> City <br /> � rf f--r--`-_----------------------------------------�---- <br /> ' •v <br /> Address _-��-� �-��-----�--------- ---- <br /> c <br /> Phoney <br /> �, .. <br /> � �----_-- - t✓ti - - License # <br /> Contractor's Name .--(._P- -- _ r - <br /> Installation will serve: Residence Apartment House❑ Commercial:MTrailer Court ;❑ <br /> Motel ❑Other ---------------------------------- -------- <br /> Number of living units------------- Number of bedrooms ______Garbage Grinder ------_- -- Lot Size _ -------- - <br /> ------- <br /> Private � <br /> Water Supply: Public System and name --------- -------- -------------------------- ---------------------- ----- <br /> --------------------------- <br /> Character of soil to a depth of 3 feet: Sand p Silt 0 Clay ElPeat El Sandy Loam ❑ Clay Loam.0 <br /> Hardpan ❑ Adobe.l] 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) f r � <br /> Li uid Depth ----142.•-,-- W I <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size------ -`--_0---------- -------- q p <br /> Capacity acit Z�?- -- Type -------------------- Material p61yAq�': No. Compartments __ -_..._. .__. <br /> Distance to nearest: Well ----------------------------------- <br /> Foundation ---------------------- Prop. Line <br /> LEACHING LINE . [ ] No. of Lines -------/-------------- Length'of each line-------- _ ---- ------ Total Length --------6.Q----------- <br /> D' Box .---_.____ Type Filter-Material __�_ -___ -Depth Filter Material <br /> ' : Wll -------- Foundation _ Property Line ---_"� -----•. <br /> Distance to nearest <br /> J <br /> Depth ------- ------------ Diameter ---------------- Number -------------------- Rock Filled Yes D <br /> No .i❑ <br /> SEEPAGE PIT [ ] p <br /> Water Table Depth Rock Size --- --------------------- - <br /> Pro Line ------------------ j <br /> k Distance to nearest: Well ----------------------------------------Foundation -------------------- p <br /> REPAIR/ADDITION(Prev. Sanitation Permit Y# -------------------- <br /> bate ----------•------- <br /> ) <br /> Septic Tank (Specify Requirements) --------------------------------------------------------------------------------------------- ---- <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------- --------- -------- <br /> -------------------1 <br /> -------------------- <br /> - <br /> -------- ---- -- - - - - - ------------- ----=- - - - - ---- - ---- -- - <br /> ------------------- ----- <br /> ------- {Draw exis#ing and required add i t i o n on reverse si d e <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> i 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 /> ----- <br /> ------------------- <br /> ----------- <br /> I/oh <br /> FOR DEPART T O LY <br /> APPLICATION ACCEPTED BY -------------------=---------- --- --------------- <br /> -- DATE .-- -- ------ <br /> - ------------------------ <br /> ------------- <br /> DAT <br /> BUILDING PERMIT ISSUED ----------------------------- ------------------ ------------- <br /> ------------------ <br /> ADDITIONALCOMMENTS ---------=---------------- - --------------------------------------------------------------------------------:------- <br /> 1 -------------------------------------------------------------------------- ------------------------------------------- ---------------------------- -------- <br /> ------ ----- ---------- <br /> -- --------------------------------------------�/V <br /> ---------------------------------------------------------------------- ---------------- <br /> -------------------------------- <br /> ------ <br /> fi---------------------- <br /> ------------ - <br /> --- ----- -- - - <br /> ---• ---- ----------- ---------- ----------- ------- _Date ---- -- -Final Inspection by: ---------------- <br /> SAN JO QUIN LOCAL HEALTH DISTRICT <br /> 4 <br /> E. H. 9 1-'68 Rev. 5M <br />