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?FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -----°----------------=---------------------------------- <br /> [. (Complete in Triplicate) Permit No. -------------------- <br /> ------ <br /> ---------------------------------------------- <br /> -' <br /> 5= V .bate Issued _7_-Z-7--7 <br /> ( =------------------------------- ------------------------ This Permit Expires 1 Year,Front Datelssued <br /> i; Application is hereby made_ to the San Joaquin Local Health District,for a permit to construct and ,instoll the work herein <br /> jj described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION --7 14 ---- ------ ----------------------CENSUS TRACT ------------ ------------- <br /> Owner's Name -- --------I- - -�- ----- - hone ft d <br /> Address ---------- <br /> ----- <br /> .. i y w-., ...P <br /> - - --'--- r �-- ------- - -Cr--- <br /> ------ ------- �----{------------= -- ------------------.....------ <br /> ��- <br /> Contractor's Name License # a�G_ �. 1_.] Phone _.-�(j-� _•- <br /> s I~�' I Residence (Apartment House Commercial :(]Trailer Court <br /> Instalfation will servet " { <br /> Motel ❑Other --------------------------------------------- <br /> Number <br /> --------------------Number of living units:------/14'Number of bedrooms _3------Garbage Grinder ----------- Lot Size _.�1_ __1/_l�� _____________ <br /> Water Suppi.y::Public System and-name --_______________________ <br /> ' ------•-------------- ---------------------------------------- - --------'--------Priya <br /> to <br /> Character of soil to a depth of3 feet: Sand].Silt❑ ___.Cfay ❑Peat❑ Sandy Loam _❑i' Clay Loam ❑ <br /> `I 4 Hardp€n ❑ Adobe ❑ Fill Material ---- ------ If yes, type _____________________ <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 permitted if public sewer is available within 200 feet,) <br /> PACKAGER TREATMENT [ ] SE PTIC TANK� Size- 1t <br /> [ l_ • Liquid' Depth . r� <br /> '• ,,r CapacityType --- Material__ rt <br /> No. Compaments __�--------- <br /> ` Distance to, neare't: Well -------- --------------------Foundation ------1_P._---------- Prop, line,__.6____ <br /> LEACHING LINE , [ j No: of Lines ------�----_----___ Length of each line^.- _�?_ - Total Length __-._l_� 3____-..__.. Q <br /> D' Box _ ' <br /> yType Filter Material ___J4_ rDepth Filter Material _____---+��______________________ <br /> ! Distance to nearest: Well ------67A_________ Foundation ------- --------- <br /> i Pro er Line _•1� <br /> ---------- <br /> p ty <br /> SEEPAGE P,IT �� Number, <br /> [ ] _}Depth �J __R-P.CVDiameter vaf ---_-_- - __ Rack Filled Yes No <br /> J� <br /> Distance to'neaeest Well. -� _ -_------------------------Rock':5ize __.___________:-e__�------_ <br /> le p ;. <br /> Foundation :-:--�G�-- ---__' Prop. Line _.c ---------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _____________}�-___._ __:___--_------------- Date ---------------------------------- ! <br /> Septic Tank S ecif Requirements) „` <br /> P <br /> Dis osal FieldP Y q S ecif Re u.irements), <br /> ,.. <br /> : <br /> _ <br /> t " r`, - <br /> 4 ----- ------------"_"-- I- •--------------'-- ---"-- '.{;---------------------------------------.------- ---- `- ------------------------------------------------- ------------- --------------------- <br /> (Draw-existing and required addition on reverse-side)---- -- <br /> G I hereby certify that I 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 /> k as to become subject to Workman's Compensation laws of California." <br /> Si <br /> B � Ti.Owtie ner- i . <br /> an owner <br /> -- <br /> ----------------------- <br /> (If other th <br /> FOR DEPARTMENT USE ONLY' <br /> APPLICATION ACCEPTED E3)' -- -- --- ---------------------- <br /> --- - DATE .2p `lJ/ <br /> BUILDING PERMIT ISSUED -_---_______ ------•- ---------------------- <br /> - <br /> -A--D----D--I-T--I-O---N--A--- <br /> - ----- <br /> ADDITIONAL COMMENTS _ ' __• ;,n------ -------- �aTE .. <br /> 4 - <br /> /` --- -- --------------------------------------- ------------------------------------------- <br /> ---------------------=--------- ---------------------------------- <br /> �s ----- ----- ------- -- :.:--- --- -------------------_--------- - -- <br /> -- - ------- _ __ <br /> ina Inspection by: _ _ -----------------------------Date --.r_�__'�--�Ca --��.----- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r <br /> E' E. H. 9 1='68 Rev. 5M <br />