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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT ' <br />° <br /> ----------------- ----------- ,. <br /> (Complete in Triplicate) Permit No: <br /> E Date Issued --1/ _�l <br />. ------------------------------------------------- This Permit Expires 1 Year From Date Issued -�-- r <br /> Application is hereby made to the San Joaquin Local Health District for aconstruct and install the work herein <br /> described, This application is made in compliance with County Or inanpere - 549 existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION �Q-��-O_------ - --�-------- yt---- -- ------ -A-- r-r-k. c SUS TRACT -�'- ---_---- <br /> w <br /> Owner's Name ---------- �' ; '�/ -------------------------------------------- -------- -.-Phone <br /> Address / ' <br /> .2-Qf = F/�6}laa, ry City ` A <br /> --- - ---- Ci <br /> Name ------------- ----.License # ---------:-------------- Phone -------------•------_..-- <br /> Installation will serve: Residence;Apartment House❑ Commercial :❑Trailer Court ',❑ <br /> Motel ❑Other ------------- ------------------------------ <br />! Number of-living units ------ Number of bedrooms --3 Garbage Grinder Lot Size J_____ _ ___4'_(/�-A----,-_ ---_ <br /> 1 -----__ - ..--_-.__.- __Y <br /> Water Supply: Public System and name ------ --- -------------------- ------------------------------------------------------------------------------ Private,,X <br /> Character of soil to a depth of 3 fe It: Sand Silt Clay ❑ Peat ❑ Sandy Loam -❑ Clay Loam .E1 <br /> _* Hardpan ❑ Adobe ❑-'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 /> NEW INSTALLATION: (No septic Itank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth ________--------_-_.--__- <br /> f l ---------------- <br /> NQCapacity =" Type Materia <br /> Distance <br /> to nearest: Well ------------------------------------Foundation ----------------------- Prop. Line ...................... <br /> LEACHING LINE [ ] No. of Lines --------.___!__________r Length of each line---------------- Total Length ---------------------------- <br /> 'D' Box ---I--------- Type Filter Material --------------------Depth Filter Material ----------------_--------------------.------ <br /> r. ::; r• Distance to nearest: Well ------------------------ Foundation--.----------------------- Property Line ---._--_----.__---.----- <br /> SEEPAGE PIT [ ] Depth --.-]--------------- Diameter ------- -------- Number ----------------- Rock Filled Yes F] No C3 .f <br /> IWater Table Depth ---------------------------------------------------------=---------------Rack Size ------------------------------ <br /> Distance <br /> ---------- -Distance to nearest: Well'----------------------------------------Foundation -------------------- Prop. Line ------------ ...... <br /> --- . <br /> i REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------_I <br /> Septic Tank (Specify Requirements)`- -- )-_ - - -- ------T27 <br /> ------ / f 7---- -_Disposal Field (Specify Requirements), ------------ ------------------------------------------------------------------ <br /> f ------------ ------------ ------------------------------ --------------------------------- <br /> i. (Draw existing and required addition on reverse' side)­ <br /> '. I hereby certify that 1 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 df the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> r"l certify that inihe performance of he work for which this permit is issued, I shall not employ any person in such manner <br /> as to becom ject to Workma ' o e an laws of California." <br /> -Signed - Owner ff <br /> --------------------- --- <br /> - By ------- ----------------------- ------------------ = ----------------------------- Title ----------------------------- <br /> (If other than owner)}' <br /> I� 1 EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----: 7 -- ------------------------------------------------------- DATE -- �- �sr= ��---------------- <br /> BUILDING PERMIT ISSUED - DATE <br /> ADDITIONAL COMMENTS -------- -- y <br /> --------- ------I----------------- <br /> --------------------- <br /> --- -------------------- --- --- --------------,----- -- <br /> ----------- --------------------- ----- - --- ---------------------------- - - ---- ---------------------------------------------------------------- <br /> - ----- - ------- <br /> f j <br /> - ----- --------- ------ -- <br /> y��y� - ----- - j <br /> Final Inspection by: s+�G�ri�✓ 1+�►� -----------------Date --- <br /> ----- t------ <br /> - SAN. JOAQUIN LOCAL HEALTH DISTRICT <br /> ' r _ <br /> E. H. 9 1-'68 Rev. 5M _, <br />