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_14.��'` <br /> ! k;y )R OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> {Complete in Triplicate} <br /> Permit No: <br /> ---------=----------------------------------------------- <br /> --------------------------------------- ----------------- This Permit Expires 1 Year From Date Issued <br /> 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 applitation•is made in compliance,with�County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .-f4d�2f_- f1' ..-- -- <br /> - - --r-ZC _- ENSUS TRACT - -`{-S ---------- <br /> Owner's Name ---�dcn��---' = �..� ---------------------- --------------------------- - --Phone------------------------------------ <br /> Address --------J ��.__---- f-rG0.' �. lJ--/-l�Q_4--'--------------- Cit <br /> a t <br /> Contractor's Name ------4 -40./Ue/ ---------------------------------------------- N-`License # --------:-------- ----- Phone --------------- -----•-------- <br /> Instailatiori. ill-serve: ` Residence ❑,Apartment House❑ Commer`-io � Trailer Court <br /> XO e �- � <br /> Motel Other _- _�jOf •e?C_ :. ..; ,�_� , ` <br /> Number of living units:__-- -__ Number of b�edrooms - -..-Ga�bae:Grinder;r ._ Lot Size <br /> Water Supply: Public System and name ------ `_f- 4_ _ - Q_- .-." ' - ------------_ _4---__ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand El Silt[I Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ <br /> Hardpans[] Adobe ❑ Fill Material -1--------- If yes,type --------------------------- <br /> {Plot plan, showing size of lot, location of'system inrelation towells, buildings, etc. must]be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or se&page pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size-_-S 5=__]L--. -=..------_-- -------E.- liquid Depth -------------------------- O <br /> S � No: lCompartments -_-CapacityType l _ �y <br /> •. ; <br /> Distance to nearest: Well ,----------._- ._ Foundation -r�---i�;{---_-- �? _.:-_.-_--_ <br /> ------------- - ------ - �� -- �--- Prop. Line ---- <br /> LEACHING LINE No, of Lines -----ea-- ----------- Length of each line._NO -------- ------ [Total Lengthp_----.._._.--._ <br /> S� #. EP <br /> w 'D' Box _-_A---_ TypJ Filter Material .&. -__�,Depth�Filter Mate�rlal --.--1?---------------------- <br /> r j ^ -Foundation _- G _�___ - Property Line ---_---------- <br /> I _---------- <br /> Distance to nearestr Well _---�,.� --- <br /> t I <br /> SEEPAGE PIT [ ] Depth ---------------------- Diameter ___`*^Number_,---r"'-h_------------- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth - ----------------------------------•-----Rock�Size. i <br /> \ A ,. -,. -,. �k Y- - <br /> Distance to nearest: Willi �_r _____________Foundation --_------ -- _----_ Prop. Line ---..-_ ......... <br /> 1.REPAIR/ADDITION(Prev. Sanitation Permit# ------ �'--------_-_--_-_-��*,____-_ Date _.-------- ------- <br /> Septic <br /> _-_--Septic Tank (Specify Requirements) ----------------. -- -----------------------------------------------•----------- - <br /> Disposal Field (Specify Requirements) ------j�l------------------------------------------ <br /> ------------------------------ ----------------- ---------- <br /> 1 <br /> Cl <br /> - --- ----------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this applis�ation and that the work will be!done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following f <br /> "1 certify that in the performan a of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to beZe,!Iuje CtO a 's ensation-laws-of-California <br /> ." ' i <br /> Signed,, Owner a' <br /> BY ------------ ------------------------------- -----" Title -------- ------- <br /> - - --------------------------------- <br /> ------------------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> BUILDINGPERMIT ISSUED --------------`----------------------------------------------------------------------------- ------DATE ---------------- ---------------------••-•- <br /> ADDITIONALCOMMENTS . r------------- ----------------------------------------------------------------------------------------------- --------------------- -----•----- <br /> I I <br /> - -- ------------ <br /> ----- ----------------- ---- ------- --------- --- --------------------------------------------------------- ------------------------ <br /> Final _ <br /> Inspection by: --- ------- ------------ ---- --------------------------------------------------------Date <br /> - J �f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M , <br />