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� <br /> FOR OFFICE USE: <br /> APPLICATION FOR. SANITATION PERMIT <br /> ..................•---•.:_--._.... <br /> lComplete In Triplicate) Permit No. ..................... <br /> This Permit Expires t Year from Date Issued 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB.ADDRESS/LOCATION . <br /> ..2.06- 4 ;E_.-.1D.th................... '"'• ..............._ CENSUS TRACT <br /> Owner's Name ..._...Mrs Wedel Phone <br /> ....------. -•---•--------------------------------------------•-•-------........ .........._.........---........._ ............... <br /> 206 - <br /> Address .................. 71 E. 10th <br /> .................................. -----------:.-.....---•..City ............... <br /> Contractor's Name Roto Rooter. Sewer ,Ser. 271,53,9 ._.-......x.65. 27616`1"­ <br /> .. <br /> ----- -- - --- ------------------•------------•---•-..-.......__........License # ........................ Phone ---- ..................-..: <br /> Installation will serve: Residence[3 Apartment House Commercial❑Trailer Court <br /> Motel❑Other-•................................. <br /> yes 75� by 100' <br /> Number of�living units:---_--I--- Number of bedrooms............Garbage Grinder .-.--.-.. Lot Size ............................................ <br /> Water Supply: Public System and name --..._itali. ....3daax ._ s ........_-..........................................:.......Private ❑ <br /> Character of soil too depth of 3 feet: Sand❑ Silt o Clay O Peat[] Sandy Loam ❑ Clay loam ❑ <br /> Hardpan p Adobe E] Fill Material ....ba..-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: 11 (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TAMC f ] ...... Liquid Depth <br /> Size -- ....... .............. <br /> Capacity ----_-------------- Type ----------••----_-- Material...................... No. Compartments ..................... <br /> Distance,to nearest: Well ......................_---.-._.---Foundation ...................... Prop. Line ............. ......... <br /> LEACHING LINE ` [ ]F--No. of Lines ------_----.--__--- Length of each line............................ Total Length _.....__...-..._-_..__..:._.J <br /> 'D' Box _. Type Filter Material _ .....Depth Filter Material <br /> g yp ............... w <br /> --- :N <br /> Distance to nearest: Well ........................ Foundation _._..._.._. ....... Property Line ....................:.. <br /> SEEPAGE PIT { ] `Depth ..................... Diameter ---------------- Number ............................ Rock Filled Yea ❑ No Q <br /> Water Table Depth -------------------------------------------....-Rock Size ................................ <br /> Distance to nearest: Well .........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----•-•------------------ _--_--_.---- Date --- .............................. Q <br /> Septic Tank (Specify Requirements) ..... old redwo-od tank and installn.ew 1.200 galjon <br /> ------------- .....---••-•----------..•_•..._....--- <br /> Disposal Field (Specify Requirements) _________________ <br /> - -•-------------------- --•- --•-----••---••----•---- ......................................... ... <br /> _ . .. __ <br /> --- •---- - ------------------------...........•-........................................................... <br /> -........... <br /> -.................... <br /> (Draw existing and required addition on reverse sidel <br /> I 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. Herne owner or licen• <br /> sed agents signature certifies the following: <br /> "I certify that in the performance 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 ------------------------------------------------------------------------------------------------- Owner <br /> By --------------- ---•-----------------• ---------------•-- -- ------------------------------------------ Title -_----""------------------- .............................. .......... <br /> (if other than owner) <br /> __-- FOR DEPARTMENT USE ONLY � <br /> APPLICATION ACCEPTED BY ---- .._._._. DATE ... _�_ - = <br /> BUILDING PERMIT ISSUED ------------------------------------­­ <br /> ------ ---------------------------DATE ....... ---------------------------------- <br /> ADDITIONAL COMMENTS --••---`........... <br /> :. <br /> --------------------------------- <br /> ---------------- --- - - <br /> ------------- ---- - ... <br /> -• •-----...-1__...... - <br /> Final Inspection by: . _..--•-••-----••---..... .................Dated.- ... -•---- --- ---- <br /> -- <br /> EH 13 .21 1.-611 ikv.. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7$ 3M <br />