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� I <br /> I FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. .............. <br /> �- in Triplicate) <br /> (Complete Date Issued <br /> ..................... ---...-----....--�I: This Permit Expires 1,'Year iron+ Da1Q 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 opplicatiori! is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> OB ADDRESS/LOCA TfON;.. -.. _ - L-7....�/..._ -:-.--.- JCt.crt!�- -...-.:-„-:. '--•.............CENSUS TRACT ----------------- ----•••- <br /> Owner's Name .............. �� `�!•. ;` -.-.-.-.....-. Phone .E?......-.... -.. .. ... <br /> ..--. <br /> �. <br /> City <br /> ........................................ <br /> .. License # S `3 _3-- Phone <br /> Contract. r fame --•---.. ..... .... ............ <br /> Installatio will serve: Residence Apartment House❑ Commercial ❑Trailer Court 0 <br /> i . Motel ❑Other - •----- ------ <br /> I Number of living units:-... 1--- Number of bedrooms -.---?7� Garbage Grinder ............. `t Size ..--... .- ............ <br /> Private ❑ _ t <br /> Water Supply: Public System and name -------------------------------------------- -------_----.....-.. V <br /> Character of soil to a depth of 3 feet: Sand❑ Silt Clay E] Peat E) Sandy Loam � Clay Loam <br /> i ! <br /> f Hardpan ❑ Adobe ❑ Fill Material ---.......-. If yes, type -- ................... . <br /> (Plot plan, showing size ,�f lot, location of .system in relation to wells, buildings, etc, must be placed on reverse side.) C <br /> NEW INSTALLATION: INii o septic tank or seepage pit permitted if public sewer i�available within 200 feet,) 011 <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ) Size-.-......--- -.x..8..-..._....- ...... Liquid Depth ----�>-. ............... <br /> Clpacity/,. 2 Type __FW _ Material.- -- _ No. Compartments ---..._.-_�.........- C <br /> d ► <br /> Distance to nearest. Well - ............. ...,� .-...------- Prop. Line -- .....---_--..-. <br /> .Ii <br /> r � <br /> LEACHING LINE No. of Lines ... .-. Length of each line .....-../..C11:).......... Total Length --�- . .............. <br /> 1T Box ...... Type Filter Material -_ -. .- epih Filterr Material ...`..i ...5 ............. <br /> i <br /> Distance to nearest: Well -.-.•................... Foundation D--.-- Property Line -..-.--.--..-_-__.-_--_ <br /> SEEPAGE PIT Dpih Diameter t . -------- ameer --------------- Number ...--.�... Rock Filled Yes No <br /> ,Ep . -. <br /> ��k P W!ater Table Depth .--- --- ..---Rock Size . - <br /> r , <br /> �( IQ Distance to nearest: Well - ------------�.------------....Foundation -1�; ._--- Prop;L'ne .___..-........ .. <br /> REPAIR/ADDITION(Prev. Sanitation Perm' # .---.--- -- —------------------- ate ------- ---••--...:.---..} <br /> Septic Tank (Specify Requirements) .... �-r. -�r -.w ,. .... ..-.-. <br /> Disposal Field (Specify iRequirements) .--_---�,f___ -- '`�+ •�-L f�a--� <br /> I� ...... <br /> ---------------- <br /> - --- - --- -- - ; <br /> 40/7 A <br /> (Draw existing and required addition on rev r d,s`de) � <br /> I hereby certify that I have prepared this application and that the work will/be dons 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 follow;+g: <br /> i "I certify that in the performance of the'work for which this .pe mit is tissued, I sha`Il not employ any person in such manner w <br /> l as to become subject to Workman's Compensalfon laws oftalifornio." I <br /> Signed . .. . ..... .............. .....- --------------- Owner <br /> By .... - I!'- - title . ... ............... ......--- .............. <br /> (I�. art owner) J r <br /> 1 <br /> k I FOR DEPARTMENT USE ONLY <br /> is <br /> i <br /> APPLICATION ACCEPTED,!�BY .. _ _ ...-.-.-.. DATE - .-." .:.7. ............... <br /> BUILDING PERMIT ISSUED ..-...-. . -...-_.._-..-- --....DATE . �'jj�.,.-.. .................. <br /> ADDITIONAL COMMENTS. ...... �, V­ <br /> 0_6,.an.5y,� `' i !....i J... :: ::::::-:::::: :.::::::: : :----------- /:.:::-- -•-------- -------� --------- <br /> r ------------- !.-.-.-.:. r ---- -------• -<--.--- - -------------------- <br /> f �' .s, ........------•------- - ................. <br /> Final Inspection by. t • �-��-, :..�--------------_--•--•--- -----------................. <br /> .-..-..---• <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F N 13 24 l.'hR l2ev_ 5Ak . <br /> 7/72314 <br />