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-F 0`; FFICE ljSl_: APPLICATION FOR SANITATION PERMIT -5 Y_ <br /> ---- -- ------------------------------ Permit No.'7 - <br /> Z - <br /> '.S (Complete in Triplicate) <br /> -------- =------- --- --- <br /> - - <br /> ----- -- ----- <br /> • - � .t......,... _. e-.�,,.-..�,... Date Issued ------------n___7� <br /> -------------------------------------- "---------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health bisirict for aper, <br /> mit to construct and install the work herein <br /> described. This application is made in c mp i nce th County Ordinance No. 549 and existing ules cod Regulations: t <br /> ' l - --- <br /> JOB ADDRESS/LOCATION _ -� -//---------=--- I✓ �1L� 't_ '� tlCEN SVTC! - <br /> Owner's Name °.' �p /orf: ` ------------- - Phone <br /> Address -------------- '--------------- --------------------------- --`---------------. City •. y --------- --------------- <br /> P - --------.--------License #; <br /> Contractor's Name f - � �� _ .• - -- Phone )-- <br /> Installation will serve:., Residence ❑ Apartment House❑ Commercial :❑T/railer Gem <br /> Motel ❑Other _-e7fK <br /> Number of living units:-_" '___. Number of bedrooms __ ____[Garbage Grinder Lot Size /&2j ' -W-______________________• y <br /> Water Supply: Public System and name --------------- ------- ---------------------------------------------------•---------------' ----------------Private <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ . Clay Loam ❑ G; <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,,type----------------------------- <br /> (Plot <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 tank or seepage pit pernu- tted if pt{blic�sewer is available within 200 feet) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size �'W- I--__-4 ,---- Liquid Depth ------------------------- <br /> AP <br /> __________________,_ _ - <br /> � No Compartm _..__Capacity , 1 <br /> Distance to nearest: Well _____� f f Foundation __ ----------- Prop Line Ae/ <br /> R <br /> LEACHING LINE � No. of Lines ----- __-__ Length of path line--liW ___._____ Total Length _ �-.__________--_ <br /> + d <br /> 'D' Box _ _ '_ Type Filter MaterialDepth Filter Materiaf �f' <br /> ---------------------------; <br /> Distant to nearest: Well _pVA��_____ Foundation - .,_______-____ Property Line. �-_______._-_.. <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter _______________ Number --------- ------------------- Rock Filled Yes ElF No 1❑� <br /> Water Table Depth ------------- --------------------------- - ----Rock Size -------------------------------- <br /> - ------------ , a'' <br /> Distance to nearest: Well _'--------------- - --_--.--Foundation ______________-___ Prop. Line..._:___ --___. <br /> ------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------- Date __________________________________) ' <br /> Septic Tank (Specify Requirements) ----------`------- --------------------------------------------------- <br /> ------------------------------ ------------------------------ <br /> Disposal Field (Specify Requirements) "-------- ---------------------------------------------------------------------------------- 3 <br /> -------------------------------------------------------------''------------------------------------------------------------------------------------- ------------------ -------------------- i <br /> - ------------------------------------------------------------------------------------------------ t <br /> (Draw existing and required addition on reverse side) , <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home 6wner,or Iicen-- <br /> sed agents signature certifies the following: i-i <br /> "I certify that in the performance of the-fork for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Com ensad"_daws of California." <br /> Signed ------------------ --- ------- Fr`Y ' <br /> -------------- Owner <br /> Title <br /> -------BY _ e --- <br /> (lf <br /> er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY Vl� 4"� ty�"�----------- -----------. DATE ------6, l - --- <br /> DATE_------- - - --------------------------- <br /> ADDITIONAL BUILDING PERMIT COMMENTS NTSD------------------------------------------4 ---•--------------------------------- -------------------------- - ------=---------------------------------:- <br /> -----------------------------------------------------------------------------------------------------------------------=----------------------------- <br /> --------------------------------------------------------------- ----------------------------------------------------- <br /> I <br /> Final Inspection b %�_- F- _ - ; --•---------- --- <br /> -----------------------.-- ---------------------------- <br /> - - -- ----------------,___. - - spate --------- 2', ------ <br /> --- ---- ---------------- <br /> SAN JOAQUIN. LOCAL HEALTH,DISTRICT CO <br /> E. H. 9 1-'68 Rev. 5M <br />