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r FOR OFFICE USE: <br /> APPLICATION_FOR SANITATION PERMIT S- S7 <br /> Permit No. . . ......... <br /> (Complete in Triplicate) <br /> This Permit Expires 1 Year From bate Issued Dote Issued ..- ~..... i <br /> Application is hereby mode to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance wi{thh County Ordinance No. 549 and existing Rules and Regulations: <br /> ..._..CENSUS T'RAC'T' .......................... <br /> JOB ADDRESS/LO TI N .............................._..:...................._.. <br /> �.......... .. --- <br /> Owner's Name � .. .. .......:.....................Phone --"---•-•--........... ............. <br /> . .. . 44—Cp � <br /> Address i�`.t ..�...- City ............................................................................ <br /> -----------•--- <br /> Contractor's Name ---- ------ --- ----------------=-----------------•. -----.._....:. License❑# ... Phone' .............................. <br /> . C ' <br /> Installation will serve: Residence ❑Apartment House Commercial Trailer Court <br /> Motel ❑ Otherr............................................. u <br /> Number of living units...... ...... Number of bedrooms _-'-.__....Garbage Grinder ------------ Lot Size ..�.-1-•���•• ......... <br /> --------....................................................Privote K <br /> Water Supply: Public System..and name .................................................. <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt[] Clay ❑ Peat❑ Sandy Loam E�< Cloy Loam ❑ O <br /> Hardpan ❑ Adobe❑ 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: lNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC'TANK I ] Size................................................ Liquid Depth .......................... <br /> CapacityType Material.................... No. Compartments ...................... <br /> Distance to nearest: Well ....................................Foundation _...._........_.. .... Prop. Line ......__........-..... <br /> LEACHING LINE E j No. of Lines ....................... Length of each line.-------------..---......... Total Length ...................•........ <br /> _.De Depth Filter Material <br /> D' Box 'TYpe Filter Material ......:........... P ....-------............._._........---....-- <br /> Distance 'to nearest:'Well .-_.. _-•------->---._ Foundation ....--•----------------- Property Line <br />` SEEPAGE PIT Depth Diameter ................ Number ...--------- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth 1....................................Rock Size ..._...........-- ................ <br /> Distance to nearest: Well .............. .......I....Foundation ..__...... --------- Prop. Line .... ................. <br /> REPAIADDITION Prev. Sanitation Permit ..................----•-•-•................. Date .................................. <br /> Septic ecify Requirements} --------------------------------------------- <br /> ` .. --- ------- .. - <br /> f Disposal Field (Specify Requirements) .._ _ �----- - -- ---- - - ' <br /> ------------------------- ---------- -----••----------------• ................................................ •---"----•------------....;.............-......................... <br /> ---"-•-•....-•-----------•------------------------------------------------------ --------------.............. <br /> (Draw existing and required addition on reverse side) <br /> l 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 liven- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance_ of k for which this permit is issued, I shall not employ any person in such manner, <br /> as to be c sub! t to Wo k s Co pe oti laws f California." <br /> Signed .X (. ---------------- - ......... :.._. Owner <br /> ......-- ----•- Title <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . ................................................I........................ DATE ..... 1-�, .......... <br /> BUILDING PERMIT ISSUED . .__ " ..........:........... . ... . . . • ---....DATE ...-....................................... <br /> ADDITIONALCOMMENTS ................:................. .........:.....•-----•--•-----------. --.........------.......--•••---------...........---.............--.......-----•_.... <br /> I ......................: ................................................---•. --------....-....--------•----•- ..-•---....._�...._.........._.._.._............... � . <br /> ----------------------- ---...... .- <br /> -------•.................. . <br /> Final Inspection by: Date _ <br /> SAN-JOAQUIN :LOCAL WE,4$TH DISTRICT P • ,..,�. , <br /> 7/72 3,M <br />