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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT -7 <br /> --, Permit No. ----- <br /> f "(Complete in Triplicate} <br /> ---------- •---------- ----- ;-" <br /> _ w 3-3 a-7 <br /> a=.,..,.,. Date Issued ---------------- <br /> -----------_-_ This.Permit Expires 1 Year From Date Issued <br /> i <br /> l'Health District for 'atepermit to construct and install the work herein <br /> Application is hereby made to the San Joaqurn:Laca <br /> described. This application is made in compliance-'With County'Ordinance Na. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION <br /> .____ -- CENSUS TRACT __. - ---- <br /> . �--��C1---.--� --- - -- - - �'Z_----- -------- --�:_ _..- .- <br /> Owner's Name ------- Q/� ---------.Phone 2317:4 J-2-1-------- <br /> Address ` -------- --- City � - ----- ------------------ <br /> --------�-/------------- <br /> Contractor's Name -------License Aa45_Rl7--- phone J-9-6- <br /> k <br /> Installation will serve: ResidenceNiApartment House^❑ Commercial ❑Trailer Court ',❑ <br /> Motif ];Other _ -----. ------- <br /> Number of living units:___ - <br /> -----. Number. of bedrooms . _a...Gorbage Grinder . ___. Lot Size' -1_x _. _1 -- __ __ <br /> Water Supply: Public System and name f_ ------_._ " - ----------------- ------------------Private] <br /> 4,. <br /> Character oF;soil=to a depth of 3 feet: . Sand ❑_-" Silt❑ Clay ❑ - Peaf❑' ' Sandy Loam)QClay Loam ❑ <br /> Hardpan ❑ ' Adobe ❑ Fill Material—0_;-__-- If yes,type -- -------I--------------- <br /> (Plot plan,,showing size of lot, location. of system . relation to" wells, buidings, etc! 'must"be>placed on reverse side.) <br /> NEW INSTALLATION•. {No septic tarik:or see ge pit permitted if public sewer-rs avaiblewithin 200 feet,} <br /> PACKAGE TREATMENT [ O <br /> SEPTIC TANK' _ Size___l6_Y_5 �.�-- .-- Liquid Depth ----------------•---,.---- <br /> Capacity 1 -d_-C7----- Type 12_ Material-� No. Comportments ..�______________ <br /> Distance to'.nearest: Well ____-- d"`______; .-- -:-Foundation ---40 Prop. Line _.._...�7____---.- - <br /> LEACHING LINE [ No. of Lines. ___. - ch-------------- Length of ealine_-__- '`M-_- Total Length :____._f_60_:..--------- <br /> ;6' Box -LJe-a..-- Type Filter Material ____ ------Depth Filter Material .......P?------------------------------- <br /> Y Distance to nearest: Well, ------------------------ (Fpundation ------------------------ Property Line, ______--__._____------._ <br /> SEEPAGE PIT T. Depth ..f_______: V_ -1-d___ umber <br /> _____.__ ,._.___________ Rock Filled Yes)o' No IQ ' <br /> Diameter <br /> Water Table Depth -------- r---------Rock Size -------------------------------- ; <br /> E Distance to nearest: Well ----------------------- --------Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION(Priv. Sanitation Permit -------------------------------------------- Date ----------------•-- ------------- <br /> Septic Tank (Specify Requirements) -------:--------- = L__:-,............. -------------•----- ' -------------------,.---------------------------- <br /> Disposal Field (SpLcify Requirements) -------------------------------------------------------------------------------{------------------------------------------------------ <br /> ------------------------------------------------- <br /> ------"-' � ' • ' ------------ ------------------------------------- <br /> a {� .-.� t._: [.f ---------------------- ---------------------------------------------------- <br /> _ <br /> (Draw existing and required addition on reverse side) <br /> i <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, Stat Lae State and RulesandRegulations of the SanJoaquin"Local-HFa—lth District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify th 'f in the performance of the!work for which this permit is issued, 1 shall not employ any person in such manner <br /> .-as.to become"subject to 'Workman Compensation laws of California." <br /> - � ..,,: ----"--- - ------------- -------- } <br /> Signed ---­------------------ � ':" Owner <br /> itleBY ,. ------------------------------- <br /> (If other.-thdn owner] T <br /> �r.FOR DEPARTMENT USE ONLY DATE <br />} APPLICATION ACCEPTED BY -Tr 5 = <br /> I BUILDING._.P_ERMLT_ISSUED_.. DATE ,,--_. .--------=------ -- --- <br /> �. . <br /> rp <br /> ADDITIONAL "COMMENTS ---- - <br /> ------------ - --------- ------ � res-`�-+�� ----------------------------- <br /> ---- <br /> --- - - ---------- ----------------------------- <br /> -----k... ------ -- - ------- -- <br /> _________________ k _-_.--- -_-- .. ____.._---------- _____ _. __ <br /> 1 <br /> .Yum-----.�. <br /> U <br /> 4.. __-_---__:___.. _ __ _ _. __.. .-_�_ _ ___ . <br /> oo <br /> Final Inspection . ------ - ---- ------------------ -------------- - --- - -----------------------------------------------------Date - ' <br /> SAN•JOAQUIN LOCAL HEALTH DISTRICT <br />, <br /> 1 ` <br /> E. H. 9 1-'68 Rev. 5M._ <br />