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-FOR OFFICE USE: <br /> a APPLICATION FOR SANITATION PERMIT <br /> ......................................--- 6 <br /> `(Complete in Triplicate) Permit No. .�� °._..__ <br /> ... .. .... ..... ..... This Permit Expires 1 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 ........�__36-0. .:...._ .. C ep ��//6 <br /> ---- ----------•--.... 1-*.. . .-- ...............CENSUS TRACT .......................... <br /> Owner's Nome �Uf�� WL .G -•..................... ................................Phone .................................... <br /> Address �j a1.. ............ :C�..rJQ�/ City / <br /> .................. ........................... <br /> Contractor's Name .......AAZv_ ............... --------------------------------License # ��..�. ` .. Phoneow,�... 6f�... <br /> Installation will serve:*g �Residence4;4.Apartment-House;EI-ComrnerckAA. ]Trailer C-oust- I <br /> 1 Motel ❑ Other . ...- ............. <br /> .v <br /> Number of living units:......_ Number of bedOm`s _�_ _.Garbage Grinder ....._...... Lot Size ............'....... <br /> .---------•............. <br /> Water Supply: Public ystem and name Private 19 <br /> Character of soil to a 41epth of 3 feet: Sand`❑ Silt❑ Clay ❑ Peat❑ Sandy Loam P� Clay Loam [] <br /> Hardpan ❑ -Adobe ❑ Fill Material ....-.-..•-- If yes, type ....... ....... .......... <br /> (Plot plan, showing size of lot, location of system in relati n to wells, buildings, etc. must be placedi on reverse side.) <br /> NEW INSTALLATION.- (No septic tank or seepage pit permitted if public sewer is available within 200 jeet,) <br /> PACKAGE TREATMEN � <br /> [ � SEPTIC TANK� j Size..._.tS_,��.1.1.5`.................... Liquid Depth ......�`�......._....� <br /> ky <br /> Capacity Type PR v Material ..........----- No./Compartm nts .....�...'..... �1 <br /> Distance to nearest: Well JVD.......................Foundation _,le-........ Prop Line .......... Q <br /> LEACHING LINE ( ) No. of Lines <br /> - -- � _-. -. - Length of each line.... ....�,Q...--.. ..... Total Lengt ......1._.`x`...4............. <br /> 'D' Box .....� ._.. Type Filter Material ./A'KV/.-LDepth filter Material ..-------1 ...................._......- <br /> Distance to nearest: Well ....67. ?_.-......._- Foundation l4............... Property Lne ...14? -"*....... <br /> SEEPAGE PIT [ ] Depth Diameter ................ Number ...- Rock Filled Yes ❑ No i❑�i <br /> Water Table Depth -..---...............--------.,-..------------.Rock Size , .............. ............... <br /> 6 <br /> Distance to nearest: Well ........................----------------Foundation ............. Prop. Line ...................... <br /> REPAIR/ADDITION(Pr Sanitation _ <br /> it# ----------- ......... Date ---- _.:..1 <br /> Septic Tank (Specif�Requireme t5Mrm.. '--.-- �- -- �- -� <br /> •- ....._------ ---------------------------. - <br /> Disposal Field (Specify Require nts) .......... -...... --------•------------ ------------------------- <br /> ..._._ I -- ------ ----y--- - ---------------------------------------- <br /> I <br /> ---------- --------------- ----------- ----- -- - <br /> ( xisting and required addition on reverse side) <br /> i i hereby certify that 1 have prepare tlfls applic ion and that the work will he done in accordance with San Joaquin <br /> County Ordinances, S to Laws, an Rues and R g..,! tions of the San Joaquin Local Health District, Home owner or liven• <br /> 41 <br /> sed agents signature certifies the foil wings Ach <br /> "I certify that in the p rformance of the work for this permit is issued, 1 shall not employ any person in such manner <br /> ' as to become subjectWorkman's Compensation laws of California." <br /> Signed _:.....�. <br /> -- ------•------------•-- ------------------••-- ---- -•--- Owner <br /> By -, . . ............. ----- :..Title _ . -_........... ....-. ...-_..... ................. <br /> (If other han owner) <br /> ' FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ._.. ... . . _1 t� ► <br /> ........................ .. ..t DATE ---6. .--- :�_')..-1............. <br /> ...:. <br /> BUILDING PERMIT ISSUED .... .... ............. . .....................•---- .. . '` ..... ....",..DATE .................. <br /> ADDITIONAL COMMENTS .....- ----- - _...... _..._. <br /> ................... <br /> ---------- ------------- --...._..... . ........................ ........... --................. .......... <br /> k --- --- ------- ----- ---- <br /> Final Ins-pection-by: ---.-------Date .... ....d.�1�"-------- - ------ <br /> I SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 1-3 241-'6B Rev_ SM -7I-7 z W <br />