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FOR OFFICE USE: <br /> k-?,"'.. - APPLICATION FOR SANITATION PERMIT <br /> ............. . . . fh .?`. ._ L.(!_. 7,5 -.7:-?7 <br /> lComplele In Triplicate) Permit No <br /> This Permit Expires 1 Year From Date Issued Date Issued ....-.:�d...7T <br /> Application is hereby made 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 CoVnPV Ordinance No. 544 and existing Rules and Regulations: <br /> JOB ADDR"S_S./LOC.ATIO, ..- .. . .... NSUS T)tA'CT �-------­---------- <br /> Owner's <br /> - <br /> Owner's Name .... ....... ..................................... Phone �.. . . <br /> Address .. . •--v- .............. City --------- .... <br /> Contractor's Name ____________________ _______ _ .... .__ -- -•.•.....___._.License Phone ..._._. _.:L�' �7----- <br /> Installation will serve: Residence ,Apartment House f3 Commercial❑Troller Court [3 <br /> Motel ❑Other <br /> Number of living units------- ----- Number,of bedrooms ... Garbage Grinder ..._....._ Lot Size __..... .T...... <br /> Water Supply: Public System and name Private <br /> �.. S .T t . . ,. �,,,,/ <br /> Character of soft to a depth of 3 feet: Sand❑ Silt❑ Clays❑ Peat Q Sandy Loam o Clay Loam ❑or <br /> IT <br /> Hardpan❑ Adobe Flll Material .... . If yes,type............... ............ <br /> (Plot plan, showing size of tot, 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,) <br /> PACKAGE TREATME=NTI l SEPTIC TAMC f l Size................................................ Liquid Depth .......................... <br /> -3,Capacity ---••--------•--•- . Material...................... No. Compartments <br /> Distance. to nearest: Well ....................................Foundation .___...._............. Prop. Line ............... <br /> V),'k LEACHING LINE ( ] No. of Lines _._--_---_----------- Length of each line............................ Total Length ............................ O <br /> . - , a� -. r ---•- ,I <br /> "' ..'"'a'. Box _........- Type .Filter Materia( ....................Depth Filter Material <br /> Distan •.--_ <br /> e'to nearest:Well...............• ......Foundation_---------------.•,...... Property Line ....................... <br /> SEEPAGE PIT `� \ t <br /> Jam, Depth . ............... Diameter .............. Number ................. .... Rock Filled .Yes ❑ No 0� <br /> I <br /> ,ate! Table Depth pth __ ...........................................Rock Size .... .............. � <br /> ° <br /> ` Distance to nearest: Well .Foundation Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit a# <br /> Date <br /> Septic Tank (Specify Requirements). . _- ..... ----... � -----;-- .--------.............. <br /> .... <br /> .r. <br /> - <br /> Disposal Field (Specify Requirements], ..---�•�-----� '. ------ =--------- .....................•----•---... .. <br /> ..................____..._4____......_____.-_........�....__.._...__. .. _____.._.... ... _ __ <br /> ....... ._•__••___-•....................................... <br /> •^�C i - (Draw existing and required addition on reverse side) <br /> I hereby certify that ! 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 cer4ies the following: R <br /> "I certify that in the perf a�rmanre 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 ------------- _.-♦`_ -- 1..-1-1- - - ----------- --••--••----------_-- Owner <br /> By ........ Title ----- --- ---- -------------- <br /> Ilf of er n owner) <br /> M!VT USE ONLY ' <br /> APPLICATION ACCEPTED BY . -------•------•-. ..... ....................... --- DATE ...- -. Or7.� ......: <br /> BUILDING PERMIT ISSUED -_-- DATE -_.._ <br /> l P�?� .. .. -------------------_ <br /> 1_� ....................................... <br /> ADDITIONAL COMMENTS/n/_--;e-.7-.. - _ ' <br /> f --_ ------ r ------_---_------. v --•----------------------------------••----•---------------------------------- <br /> ----------------------- <br /> Final Inspection : _ T_- 8.... ...... --------------------------------- .. _. _..__.._._......,.Date - l T �--- ------------- <br /> EH 13 2h 1-68 liev• 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7ii 3M <br />