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FOR OFFICE USE APPLICAT10k Ff3R SANITATION PERMIT Permit No: <br /> (Complete ' Triplicate) ^ <br /> ---- --------- <br /> Date Issued --__ Z_L-- <br /> __�-------___------- _ This Permit Expires 1 Year From 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 Regulativ6s: <br /> JOB ADDRESS/LOCATION . •, - �� `�--------- Gf ,U /Y L,' T. --..CENSUS TRACT. ----------- <br /> iOwner's Name F l �'Lr /Q_ ------------•---------- ---------------------------------------Phone ------------------------------------ <br /> Address --------C A �---------------------------------------------. City [-�1v----------------------------- <br /> Contractor's Name ---- 1�AbAcense # - *2, 3- -- Phone <br /> Installation will serve: Residences Apartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other ------------ ------ ---------------- ---- O <br /> Number of living units:----�Y`= --- Number of bedrooms ___,7 -3Garbcge Grinder`_0' Lot Size J"_�-------- ------------- <br /> Water Supply: Public System and name -------------cam -_ c t'f------------------.----------------------------- ------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt O Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe X 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 /> i <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK[ ] Size----_--e�,2_ o_I9----------------------------- Liquid Depth -- ---------------- <br /> Capacity _L_-Z_0--0---- Type -------------------- No. Compartments. -i _.____=-•-- �'' <br /> Distance to nearest: Well ------------------------------------Foundation ---1fF-------------.Prop. Line ------------ <br /> .. ------_. -- Length of each dine__:--` - --------- Total Lng# <br /> ' eh =_ - .f_______--- <br /> LEACHING LINE { ] No. of Lines _--- - i t j n+-i1 <br /> }' 'D' Box ---,�--- Type Filter RMaterial ��.�� -_Depth'�Filter�Material --------------------•------- --'--------- <br /> .w..-- <br /> Distance to nearest: Well ------__=� ____---- Fo undation { _________________ Property Line --- -------------­- ' R <br /> ' SEEPAGE PIT [ ], Depth -------------------- Diameter ---------------- Number ---r__ ------------------ Rock Filled Yes ❑ No .>D <br /> 'a Water Table Depth -----------------•---------------------t-------Rochize -------------------------------- <br /> % <br /> ---------------------------- --% 9 <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .--------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -----_--------------- `"'------" ".Date-------------------------------- <br /> } <br /> Septic Tank (Specify Requirements) -------- ---------- ------------ ------------ ----------- <br /> Disposal Field (Specify Requirements) _- ___ -- -----'___- - -- <br /> ' -- --------------- ---- ----- -- ---- -----,----------- <br /> - <br /> _ r <br /> �f- - ----- --- -i-I d required addition o---an --- ------------------------ <br /> i {praw g n reverse side) <br /> fi 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. Home 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 /> i as to beco a ubject to Workman's compensation laws of California." <br /> Signed <br /> BY =G-f_ '-'t- ---=' Title - = <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------- -- -------------------- ------------ DATE <br /> BUILDINGPERMIT ISSUED -------------------------------- ------------------------------------- -------.DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS - ------ ------------------ - - - -- --------------------------------------------------------------------------------------- --------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> �. ---------------------------- ------------------ -------- ---------- --------- - --------- ---------------------------- <br /> ---------------------------- - <br /> �-f j ------ <br /> --------------------------------------------- ------- ---------- ---- <br /> Final Inspection by: ---- --------- ------------- -------- Date = - <br /> SAN JOAQUIN LOCAL .HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />