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FOP, OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit Na: -7.L-_T_- <br /> ----- <br /> ! <br /> ---------------.---------------------- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is herebypade 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 with County Ordinance No. 549 and existing Rules and Regulations: <br /> ? ' <br /> JOB ADDRESS/LOCAT N -- 67,2 -----------------------14`---------------- CENSUS TRACT <br /> C -- --------------- I - -�Phone <br /> Owner's Name ------- ---�2_��,-- ----- -------------� ------------------------------ <br /> - --------=--------- <br /> „ <br /> Address -- - / //4le�------------------------­. Cit ' <br /> Contractor's Name -----�-57^41 --------------------------------------------------------------.License #------ ---:-------------- Phone ------------------------•-•- <br /> Installation will serve: —y.H_. -Residence ❑ Apartment Noose°❑ Commercial-❑Trailer Court Cl <br /> Motel ❑Other --------------- <br /> /-7 f <br /> . � :. <br /> Number of living units:_'_` --- Number of bedroomaGarbage Grinder ------------ Lot Size6 <br /> ------------------- <br /> Water Supply: Public System and name __s!________________ --------Private ❑ <br /> Character of soil to a depth-of 3 feet: ..Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam '❑ <br /> '- J Hardpan F] Adobe Fill Material _____ ------ If yes,type ----------------------------- <br /> I <br /> (Plotlan, showing g �Y size•�of•iot,f.location of system in relation to- wells, buildings, etc. must 6e placed on reverse side.) <br /> NEW INSTALLATION: (No'`septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size--- <br /> --------------------------------------------- Liquid Depth --_----------------------- I <br /> Capacity - e�,;?; Type _ /ip _ Mdterial------i AA-CIL No.,Compattments ____ —______•- o <br /> Distance to,nearest: W�11 ____"-7�'______________Foundatio/n _��-�- n� Prop. Line __ ---------- <br /> LEACHING LINE [ I No. of Lines ---------I? Length of each line-5,291 <br /> --- - Length <br /> 1 Tot 1 <br /> `D' Box ---- Type Filter Materia ,4l 4, - �i ep Filter Material _______L--1______________•-•- _ I <br /> I f- f = <br /> Distanced negrest:-Vyell _: _- ____---w..Foundation-__ -fl -------- -Property Line __-.S: _-_-_f.__ <br /> Depth-x=_1 49 Diameter ---------------- Number ,----------___-------_------- Rock Filled YesNo <br /> Water Table Depth ------------------------r -Rock Size --- -----`------- <br /> -- - Foundation -------------------- ProLine --------•-------- - <br /> Distance tonearest: Well ___________________------ _ _ - ------- p. _ <br /> REPAIR/ADDITION(Prey. Sanitation)tt Permit# -------------------------------------------- Date ----------------------------------- <br /> Septic Tank (Specify Requirements ) ---- --------------------------------------------------------------------------------------------------------- ,. <br /> -Disposal Field Field (Specify Requirements) ------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------------------------I------------------ ------------------- ------------------------------------------- <br /> ------------ ----------- -----------------I------------ ------------------------------------- <br /> ,I(Drawexisting and required addition on reverse side) <br /> I hereby certify that I have preparled 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 certifies the following: <br /> "I certify that in the performance of the work for which this ermit is issued, I shall not employ any person in such manner <br /> as to become sub'ec man'sf'Co ns on la s ifornia." <br /> Signed -- ------ - --------------- ---- ------------ <br /> Owner <br /> By --------------------------------------------- ---- Title ---------------- <br /> -------------- <br /> (I other than ow r) <br /> XA DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY __-_ -- ---- -- ------- -- -- -______-_. DATE -_7:--P-1--"71____----_- <br /> ------- ----------------------------------- <br /> BUILDING PERMIT ISSUED ------------ -I------ -----DATE ---------------------------- <br /> ------------------------ -------- ------------------------------------ --------------- <br /> ADDITIONAL COMMENTS -------------------------------------------- <br /> ---------------------------- <br /> -------------------------- <br /> ------- -•---------------- <br /> F- <br /> ----------------------------------------------------------------------------------- -------------------------------------------------------------- ------ <br /> - -------------------------------- <br /> = --------------------------------------- ---------------------------------- --- �t <br /> - -------- - <br /> Final Inspection by: ------- szC = <br /> 7 - --- --------------------- ------ - ---------------- -------------.Date -- --- C <br /> SA J AQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />