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I <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> -----------------�:--------- ----------- Permit No. Z <br /> 11 (Complete in Triplicate) <br /> -------- - Date Issued <br /> -- ---------- ------------------------------ r Z2 72 <br /> !I - This Permit Exp ires 1 Year From 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 <br /> �.__1 ! 1--1 �l = L/� L_1_"u CENSUS TRACT <br /> Owner's Name --- ].JC.(��/i�l'�-,. � 51� � C�-------------------Phone <br /> Address -01-- �' �^�"`.0 - -----------------------•--. City ---- ^�"�-`-'' '�''` ---------------- ------ <br /> -- '/ <br /> Contractor's Name ___- ------.License #v _ ------- Phone I..w— <br /> Installation will serve: Residence VApartmen House❑ Commercial ❑Trailer Court ❑ <br /> i Motel ❑ Other ----------------------------------- -------- <br /> Number <br /> - ----Number of living units:- ------ Number of bedrooms _;Z Garbage Grinder ------------- Lot Size ----------- <br /> Water Supply: Public System and name -------------------------------------------------- ------------------------------------- <br /> ___LCl -- _ ____ Private ❑ <br />} Character of soil to a depth of 3 feet: Sand'[-] Silt❑ Clay Peatjo Sandy-Loam ❑ Clay Loam 0 <br /> a Hardpan ❑ Adobe'❑ Fill Material ------___--- If Yes,type ---------------------- ----- <br /> k II <br /> {Plot plan, showing size of lot, location of system in relation t'o wells, buildings, etc. must be placed on reverse side.) <br /> 'NEW INSTALLATION: (Nl septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ j Size----------------- ---=-------------- ------ Liquid Depth ______--_.____ --------- <br /> capacity Type <br /> Material__------------------ No. Compartments _________ ______ ` <br /> Distance to nearest: Well ------------------------------------Fou ndation­'N----------- -------- Pro p.=-Line ------------- <br /> ------------ Length of each line-----1-0-0----- ------ Total Length ;_���----------------- <br /> LEACHING LINE [ ] No. of Lines __________ �! <br /> _ 'DBox ....I------- Type Filter Material Z_---JcooJ-Depth Filter Material ----/_8__________________________________ ' <br /> Distance to nearest: Well __&.V___-----------_Foundation ------------- ---------- Property Line_ __-__.__.--._____--__--- <br /> SEEPAGE PIT [ ] Depth ____________________ Diameter _____-_________ Number ._--____.-________i--------- Rock Filled Yes ❑ No 0 <br /> ' Water Table Depth --------------------------------- <br /> Distance :.Rock Size <br /> stance to nearest: Well --- ------------------------------------Foundation ------------------ Prop. °Line ---------------.-_-- <br /> k V <br /> -REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- - -------- Date ---------------------------------- <br /> Septic <br /> ----------------------.-------Septic Tank (Specify Requirements) -------------------------------------------- ----------------------------------------------:-----------------• --------- --------------- <br /> Disposal Field (Specify Requirements) ___/O_Q....... GI�-- --- - <br /> -------- <br /> -------- <br /> ------i --------------------------------- <br /> ---------------------------- <br /> . <br /> I` ----------------- <br /> II --------------------------------------------------- <br /> r --- - ---------- ---- ------------ -- ------ '-- ---- ---------'------ -- - ---------- -- <br /> I hereby certify that I have prepared rth s application and lthataddition on reverse side) <br /> • Y � Y P p <br /> e work will be done in accordance with San Joaquin <br /> C .County Ordinances, State PLaws, 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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> ,I <br /> Signed - - ------------------------------------------------ Owner <br /> rA <br /> BY ---- ._ --------- Title - ._ -------------------------------------- <br /> (If omil� <br /> FOR DEPARTMEW USE ONLY <br /> APPLICATION ACCEPTED'�BY=---- - - --- ------ -------------. DATE 2 <br /> - =_----- -- <br /> BUILDING PERMIT ISSUED ---- ----------------------- DATE <br /> - ------------- <br /> ADDITIONAL COMMENTS ------------------------------ --------------------------------------------------------------------------- <br /> ----------------------------------------------------- <br /> ii ----------------------------------------------------------------------- <br /> II <br /> ----- <br /> �i =� ----- ---------- -- <br /> - - --- --- -- <br /> Final Inspection by: ---- - / sem..- --- ------------- --------- --------------------------'--------- Date <br /> IM �J SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />