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FOR OFFICE USE: ; <br /> f , APPLICATION FOR SANITATION PERMIT Permit No, <br /> . -- ----------- <br /> (Complete in Triplicate) <br /> --------------------------------------------------------- <br /> Date issued <br /> ------------- ------------------------------------------- This Permit Expires I Year From Date Issued <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 com liance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOClc_"� <br /> N a�_- BI I -----"-""-". - -------.CENSUS TRACT '716-----------------.. <br /> j Owner's Name ---- �------- �------------- --------------- ------ ---------- - Phoneyf�-' t-- ----- <br /> Address ---------- - /�-s------- C-t----� ------- City = ---------------------------- •------ <br /> Contractor's Name ---_ G� � -- License # 1 ' x ,3----- Phone . . <br /> Installation will serve: Residence [R<partment House,❑ Commercial : Trailer Court f <br /> Motel ❑Other ----------------------------- -------------- <br /> Number of living units:.... Number of bedrooms __3.---.-Garbage Grinder -------_---- Lot Size ...._--__-"..-__._-_______________________ <br /> l .• <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 /> Hardpan ❑ Adobe Fill Material ------------ If yes, type ........................ ... - <br /> •t <br /> {Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)t <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> a <br /> PACKAGE TREATMENT [ 2 SEPTIC TANKf�- _ Size-- _---------------- Liquid Depth ...._ - ---- <br /> Capacity I-n�:d__d_____._ TypeY- 4 ------ --- Material ---- No. Compartments ------ <br /> s <br /> Distance �to nearest: Well ------.�__� -----------Fou-ndation --- -- ----------- Prop. Line ----4!. .� <br /> LEACHING LINE No. of Lines ____-_C9------------ Length of a ch line._9 ._- - __ Total Length , Ca............ . <br /> D' Box .�".__�__- Type (filter Material !. �_�i�Depth Filter Material ----,��__________________________�.' <br /> Distance to nearest: Well -_,5Z--------r__ Foundation -_PPO..........-. Property Line ----------- -f�- <br /> I � <br /> SEEPAGE PIT [ Depth .a��__-.__ --- Diameter .a_$_.._...._ Number .______�--------- ----- Rock Filled Yes g-- No C1 <br /> i rr .. <br /> r Water Table Depth ---- --0------------ ----- --------Rock Size _99XA-----�--------- t <br /> t � ` <br /> Distance to nearest: Well ... .....................Foundation ..... Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------__---------------------------------- Date ---------------------------------- <br /> Septic <br /> ----------------_-_-------------Septic Tank (Specify Requirements) -------- -------------------------------------------- ------------------- -----------------------------n <br /> Disposal Field (Specify Requirements) --------------------------------------------- -------------------------------------- ----- ------------------------ ` . <br /> -------------------------------- <br /> --------------------------------- ------------ ------------------------- --------- ------------------------------------------{--�-,7 <br /> ----------------------- ------------------------- ------------- <br /> I hereby certi that I have prepared this li at on an wired additiogn on reverse side) <br /> (Drawexistin and re <br /> y fy, pep app dlthat"the work will'be done in accordance with Son Joesgwin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin.Local Health District. Home owner or Iicen- <br /> sed agents sig ature certifies the following:, __,;j _F <br /> "I certify that in the performance�af the work for which this.permit is issued, I shall not employ any person in such manner <br /> f as-to be �me s bject to ark t n's Compensatio,9laws of California."- <br /> Signed <br /> alifornia.Signed - ------------ -------- ,.L. ----- Owner <br /> � I . Title <br /> u By ..------ --- <br /> (If other than owner) <br /> F DEPARTMENT USE ONLY <br /> iAPPLICATION ACCEPTED BY - ------- -------------------------------------------------- --------- DATE ------- -------- =------ <br /> BUILDING PERMIT ISSUED ... _ " --- - DATE ----------------------- <br /> � . x `------------------------------------------------------- -ADDITIONAL COMMENTS - ----- ------------------------------------------------------ <br /> " =' <br /> l <br /> -------------------------- --------- --- •=- - - ------------------------------- ----- ----- -------------------- ------------- ----------------------------- ------- <br /> FinalInspection by: .------ ' -- ------------------------------ ---------------------------------------- --- ----.Date ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> k <br /> c y <br /> s E. H.'9` 1-'68 ev. 5M <br />