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r , <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> .• Permit No- -----------------•---- <br /> - ---------I` (Complete in Triplicate) (} <br /> f � Date Issued ----_l.�l� -?6 = <br /> --------------- <br /> ----------------- This Permit Expires 1 Year From Date Issued <br /> 1� <br /> Application is hereby made;[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 with County Ordinance No. 549 and,`existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION jl °fes R 'i---=�'------ - --------------------CENSUS TRACE i <br /> Owner's Name .�Y -rmP ( 2� :.--•-----------= ---- ------------ Phone = <br /> - <br /> Address ------- - rE' Citr"` <br /> r -& Y <br /> Con#ractor's Name --_ _ _-.License # --�-19-8 3Phone _--- <br /> ----- ----- 4---- <br /> 4 ,Installation will serve: Residence r partment House❑ Commercial :❑Trailer Court ',0 <br /> i <br /> Motel ❑ Other --------------------------------------------- <br /> Number of living units:-----1_-- ` 3j`------- <br /> .-_ Number of bedrooms -_--_ _-__-_Garbage Grinder -------__-.. Lot Size ___ �----- <br /> --- <br /> Water Supply: Public Syster i and name_ -s ---- - -----------------------• --------•------- ---------------------Private E� <br /> Character of soil to a depth iiD f 3 feet. Sand'❑ Silt 0 Clay [� Peat❑ Sandy Loam .F] Clay Loam ❑ <br /> I..Hardpan.[],Actobe-M—Fil.I-Material-------•----If yes,-type,-,;------.--4_------- ---L� <br /> t M <br /> (PI'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} i <br /> NEW INSTALLATION: (Noy septic tank or seepage pit permitted if,public sewer is available within 200 feet,) <br /> SEPTIC TANK 5ize.- t Ir <br /> ------------_------- <br /> Capacity <br /> + j� <br /> PACKAGE TREATMENT [ ]I� [ S X__�o-_-_X----- --- ------------ Liquid Depth .-.-------------•------- <br /> } Ca� acitType <br /> w � � <br /> - T e - Material__�`1�R,_ No. Compartments <br /> •lt: Well --------- � -------Foundation ------l.a---------- Prop. Line ---._--Distance 160 <br /> LEACHING <br /> LINE [!'f No� of Lines ---___ ---- Length of each line:_-_--1_D.4-_°_.._.-- Total Length ,-_ �_�--�_-_-.-.- <br /> - 1. x <br /> I D' Box .__- - Type Filter Material---��j�- _Depth-Filter Material ----f41---------------�..J_•-.-.:-_._ <br /> Distance to nearest: Well ------ > ------------ Foundation'•-_____r A-_�--------- Property Line, ---------------- <br /> i <br /> SEEPAGE PIT [ Depth ........ 5---___ Diameter .___ 7 -____- Number ------t; Rock Filled Yes [ J` Na i❑ <br /> Il . ., <br /> Wr"ter Table Depth -------------------qb----------------- -----Rock Size = ----C---- ": <br /> r �} <br /> IMI - � -. ,.1"' � --1-�-------------- Prop. Line -.._- --•------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------ --------------- --------------------- Date --_-_--_- <br /> Distance to.nearest:,Well ----------- I-0-!CZ.. <br /> ---------•------------ } <br /> Septic Tank (Specify Requirements) ---'�----------`---------------- ----------.------ii------- ------------------ ------- -------------------.•-_--- <br /> I Disposal ..Field (Specify �Requirements) ---------_-_ <br /> I�iF ----------------------------------- <br /> -------------------- --------_----------_ -----------------------------------------_____----_--"-"'-- __-.___-----.---_ <br /> ___________________ <br /> --- -- -_ } <br /> -----------'__-__.------ _------3-I�_------ -- ------------------------�- -------I--------------------------------- - -.____----_------------------------------------------- .----- <br /> ,," {l]ra.w existing and req�ir�ecl_addition on reverse side}_.. -_, . t. <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, StateLaws,.and Rules and Regulations of the San cf quin.Local Health District. Home owner or licen- <br /> sed agents signature certifies.the following: <br /> "I certify that in the perfoi"nce 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 ----------------- I" ----------- Owner <br /> BY I Title --- <br /> ---- -------- <br /> (If other ari�owner) <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY r I ------------------- DATE -- ----- j� �� ------- ------ <br /> BUILDING PERMIT ISSUEDj[----------------------------------------------------------------------------------------------------------DATE <br /> ADDITIONALCOMMENTS,-------- ---------------------------------------------------•------•--------------------- -------------= <br /> 0. <br /> ----------- ----------------- -=-------------------------------- <br /> -------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------- --------- <br /> F ------- - ------ <br /> -------------------- I �--- <br /> Final Inspection by: ?b_._ - <br /> - - - -- -- - -- - ---------------------------------- <br /> Date �. r -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> is <br /> f� <br /> ` E. H. 9 1-'68 Rev. 5M;' >. .. <br /> i <br />