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°r <br /> .... _ <br /> FOR OFFILE USE: <br /> I APPLICATION FOR •SANITATION PERMIT i <br /> 73_ g <br /> ' iM Permit No. .. ......�... . ... <br /> J (Complete in Triplicate) <br /> r.. rf •. .. !I Date ISSUed .`S��.Z _70 <br />............................... .c:. -.. .. ! This Permit Expires l Year From Date Issued <br /> I <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/LOCATI N ...:........y2/ .........acc c :E................. •-- ..............................CENSUS TRAGI ...:...:..:..::..... . ! <br /> Owner's Name :.......... . ;- _ .......... QaS-. ,t`l..........................•--... ......:............ <br /> .........:....: ..Phane 6-a- 3 .... ` <br /> Address :......:......... h�`� ....... City �----�--1-.!1-..-4.. <br /> . <br /> actor's Name -------------- �f-4.rs� �..5:!�.s...............................License,# .;.......,............ Phone ......... ..,...... ; <br /> Contr .. �. ... <br /> Installation will serve: Residence;(Apartment-Housed-Commercial-OTrallerCourt- ] <br /> ;.. .. Motel ❑ Other _.. ......`......-----•-_.... <br /> r - - y <br /> Number of living units:............ Number of bedrooms _3.......Garbage Grinder ............. Lot Size '...`::..:.._::_ ....... <br /> name .....---•--=------=-- ................:. . ..Private ❑ <br /> Characterofsoil too depth of 3 fee ,I <br /> Water Supply. Public System and n ......... _....... ... . ..: <br /> p ��t: Sand's Silt❑ Clay ❑• Peat, •Sandy Lna'm Q � Clay Loam��, sJ <br /> Hardpan ❑ Adobe Fill Material .:__: if yes,type <br /> r i <br /> {plot.,plan,. showing size of Iot, location of. system in relation .to wells, buildings, etc.' must be placed on reverse side.) <br /> NEW,INSTALLATION: . (No septic lank or,seepage pit permitted if public sewer is available within 200 feet) i <br /> PACKAGE TREATMENT ( ) SEPTIC TANK 1j ] Size;................... ti Liquid Depth s <br /> -•-------••••..•---- <br /> CapacitY • Type ........... Material.......................... <br /> Noc Compartments ..... ..:........... \ <br /> Distance to nearest: Well ................................. Joundat of n ..._................:. Prop. Line .................. .. <br /> —.-LEACHING LINE [ ] No. of lines ... Length-of each line------------................ Total Length ........... ' <br /> vI: <br /> D' Box Type Filter Material ...............Depth Filter Material <br /> " Distance to nearest: Well Foundation <br /> ••---•----• ........................ <br /> Property Line = _:_ :_.:'- ::...� i <br /> SEEPAGE PIT ( j Depth. -------------------- Diameter ................. Number .............. Rock Filled Yes Q.-.. No.Q <br /> Water Table Depth ...........................................Rock Size : <br /> Distance to nearest: Well ....................................,:..Foundation .'Prop. Line' <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........... Date _............. . .. ... i <br /> ---•-•---•----..... .). <br /> s Septic Tank'(Specify Requirements) .................. .............. ................ .... •--------••--- __.. .._.... ----- . .. <br /> f : <br /> { <br /> Specify q N• <br /> Disposal Field S ecif Requio�✓�` � '---_ _ .� �4x .. .....3 ..X_?S_... !. <br /> ".Pat ; <br /> -=---•...............:_...---------------------------------------- ---------------------------------------- --------------------------------------------------------------- <br /> i <br /> e <br /> ---------- <br /> ------------------ ------ ----------------­--- ..................... ........... ........................--------.------_ .......------•__----........._._.._....._..........•.............-........ <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 San Joaquin I <br /> County'Ordinances, State Laws, and Rules land Regulations of the San Joaquin Local Health District. Home owner or licen. i <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 trianner <br /> as to become subject to Wo an's€€ Compeniation-laws of-California." – <br /> Signed ::: -- 'i---- -- ----••----•....................:... Owner `. .. I <br /> Y <br /> B .. .... -_ _ _7 - – <br /> .�..T. . :.----••--•--•------.. �the --•- - -lr' # <br /> (If other than owner) µ <br /> FOR DEPARTMENT USE ONLY <br /> f ' <br /> APPLICATION ACCEPTED BY ..... = DATE'...�. .. ...... <br /> BUILDING PERMIT ISSUED ...-----....i!....:....... .... :......._...................... ::.:DATE ........ ................................. <br /> ADDITIONAL COMMENTS <br /> --- <br /> ---------------------------- -- -- �::::: -f :::::: �� <br /> " . _..._.....a. ............ <br /> Fina.- •.. ...................•--` -- ' � 7 <br /> Inspection by: _ 'i:• y......... ..................Date .:.,3. ,: .. .,...f........ i <br /> SAN JOAQUIN -LOCAL. HEALTH DISTRICT r G <br /> E:#i 13 24 1-'68 Rev. 5M ! _ 7/72 3'M E <br />