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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete In Triplicate' ` Permit No. .7 <br /> S <br /> ...... <br /> r <br /> This Perm ItExpires Z Year From Date Issued <br /> Date Issued ..�-.�:.7... <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 ........._..603 Coolidge ,` ...CENSUS TRACT <br /> .........................................................•--...................... <br /> Bob McGee � -- <br /> Owner's Name ...................... .........................................•--...-......_.....-------,....................:................Phone ..........•........... .......... <br /> Address ................ 58 W. B .......... ....City .-St.ocktona _ <br /> Contractor's Name ------Roto Rooter ­11 .................License 7.1539........ Phone --.-- 6�r�2b�6.... <br /> Installation will serve: Residence[3 Apartment House❑ Commercial❑Trailer Court <br /> 4 � • <br /> 1 Motel ❑Other ......2.................................... <br /> yes 36 -77 b7 122.7 <br /> Number of living units.-..--------- Number of bedrooms Garbage Grinder <br /> Lot Size ......................... .............. <br /> Water Supply: Public System and name .C.a1if... .Xat.er...• .0p-pl.. ............................................................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ <br /> Hardpan❑ Adobe-J. Fill Material ...JaQ.... If yes,type ............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse slde.) <br /> NEW INSTALLATION: (No septic tank.or seepage .pit .permitted if public sewer is available within 200 feet;) <br /> PACKAGE TREATMENT [ ] SEPTIC TAMC fxj Size.... bY.-5.'..-_x-7....9..`....... <br /> ._ Liquid Depth .:.4 .'............... <br /> � <br /> 1200 precast con 2 <br /> Capacity -------------------- Type .............. Material ........... No. Compartments .................... <br /> Distance.to nearest: Well .... /-a "~`.^- . Foundation ...lay.....-...... Prop. Lines t.................� <br /> LEACHING LINE No. of lines 1------------------------ Length of eoi:h, line....... Total length .... -� i.............. <br /> no - r-ock �. .... 18,1 <br /> 'D' Box ......I..--- Type Filter Mdteriai ....................Depth .Filter Material ................................ ...... <br /> Distance to nearest: Well ......-n-/.a......... Foundation ---1- ............... Property Line ..5.1.................E <br /> SEEPAGE PIT (f •Depth ....�5......../� Diameter 36.''......_. Number ---------------�-.....__..__ Rock Filled Yes ® (fib ❑� <br /> i ¢' <br /> Water Table Depth......................bg .....................Rock Size ........,b....3 n.......... <br /> Distance to nearest:.-Well ---.------I......................... <br /> ..-Foundation---r_................ Prop. kine .. ............ <br /> REPAIR/ADDITION(Prev. Sanitation Permit _----!-.�...................---- Date -c...... ......... . <br /> SepticTank (Specify Requirements) ....... ...... ................•-••............................. ............................... ------..... ....................... <br /> Disposal Field (Specify Requirements) -------------------------------•---......_.-...------------------•--------•-- -----------------•--- .......................... .. <br /> ---------------------------------_----------- - ------------------------._....._•.....---•-------------------........----------- <br /> -.................................. <br /> .... <br /> (Draw existing and required addition-on reverse side) <br /> 1 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 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 /> as to become subject to Workman's Compensation laws of California." i <br /> Signed ---- - ---- •---- - -------- -- f ' - Owner Contractor . <br /> g ------- ----- - <br /> �.! -------------- Title --.--�---•------- ------• - - -- <br /> (if ther than owner) <br /> R DEPARTMENT USE ONLY <br /> AP LI ATION ACCT=PIED 8Y . . --------- DATE <br /> i` BUI ING PERMIT ISSUED -------- -------•------ --._............_..... -• ....................... ------------ .......DATE --------------._...._.......... <br /> ADDITIONAL COMMENTS ------•------------------------•---------- <br /> -- _ ._..:.~..._.:-,..._...-.. <br /> ---------- ----------------- -•-------------- -------------------------•-------------------------..---•--•..... ------------------ --•-- •- .._..---.... ........................... <br /> � t <br /> ---------- --------•---....... ------------ --- ------ -------------------- ----_.--..---------------..-..---------............_..-------•.._.-._......------... ..------ <br /> •--------- ------------------------ ------ _-. ---- --------- <br /> .............. <br /> I Final lnspection by: .. - ------ ------------ -- - -- ­-----------_-----_-------- --•---—...•-- . -------.Date ..- <br /> EH 13 .24 1-68 Rev. SAN JOAQUIN LOC I. HEALTH DISTRICT S/7h 3M <br />