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FOR OFFICE USE: " <br /> - r APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------------------ <br /> (Complete in Triplicate) Permit No. <br /> - <br /> --------------- This Permit Expires I Year From Date Issued D to Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct Ad install the work herein <br /> E described. This application is made in compliance with County Ordinance No. 549`and existing Rules and Regulations: <br /> nn ` ► t 4 <br /> # JOB ADDRESS/LOCATION - - iJ_� �!_I_S�O ------------ i, <br /> ..f. 3 t i---- -----CENSUS TRACT --- <br /> Owner's <br /> -Owner's Name ----------- �---------- --�1�{'-��.-----------------: - P---------------=-a!_------- --------€€hone t------------------------------•---- <br /> ----- -I '-3 <br /> Address d _�vl, d tV----------------------- --------- City - <br /> q F i � Phone <br /> Contractor's Name ---- _1h� _ ( ----------- ------------------- - '-,-- <br /> ------------------- License # ------------------------------ <br /> �i + <br /> Installation will serve: Residencerj&th <br /> ! partment House❑ Commercial :DFrailer Court <br /> r � vMoteer _---Mfl_VV_0---/14------__.•---- l <br /> ` r l! fS'-eve Lr Tti <br /> Number of living units----/------ Number 6fbedrooms -2—---Garbage Grinder _Q___ Lot SE�ze)___ __ ---------------------------------- <br /> Water <br /> ____ ___________________________Water Supply: Public System and name ------------------------------------------------------------- --------------- ---;--------• --------Private <br /> Character of soil to a depth of 3 feet: Sand,0 Silt 0 Clay ❑ Peat❑ Sandy Loam Clay Loam <br /> Hardpan ❑' -Adobe-'E] Fill Materiel__ _p-- if yes,aype~i ----------"" `} "-_- ^ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildingsk etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank'o_r seepage pit permitted if ublic sewer is available within 200 feet,) <br /> F <br /> { ] SEPTIC TANK Size___-- _--X_�[7--x--7---- --.----- Liquid Depth <br /> PACKAGE TREATMENT ---,7__--'-------------- <br /> Capacity d_Q�/\Type P4'�_F D_ Material-CBNIMI %a. Compartments ___�s _•:---- <br /> istance to nearest: Well --- �-- �__---___-..f=oundation ___1Q__" 1____ Prop. Line __S-1"`..`...._ <br /> I / <br /> LEACHING LINE [ No. of Lines;_ ` --� .__\---__ Length of each line_____._-O__-_______ To)al Length ......Igit Box __�S Type FilterMate�fal IC7f. c _Depth Filter Material I___ -11 --------- --------- ........:.... <br /> _ . <br /> Distance to nearest: Wel! __ Foundation 1 ------------- )Sroperty, Line <br /> fi <br /> r SEEPAGE PIT [ ] Depth ____________________ <br /> Diameter, ______ `'_` �Nimbe _____L __.____. _________ Rock Filled Yes ❑ No i❑ <br /> ��� _ <br /> A ater Table bepth ------------I---------------"'-\.n- __' ' Roc Size ----------- f I <br /> �Z0.�*�� / I ,.y - V.- <br /> <4 <br /> Distance to nearest: Well -J----------------------------------Foundation I------------------- Prap: Line ------- ------------- <br /> REPAIR/ADDITII;YN(Prev. Sanitation Permit�# ---------.�____.______--------_--________ Date ------------)......._------------- <br /> } � <br /> Septic Tank {Specify Requirements)' ------- ------ ------------------------------------------------------ ----------- ., <br /> y <br /> Disposal Field (Specify Requireme ts) ------------------------- -----------I-2- ----------------------------- <br /> b --------------- ------- --------- -------------------------------------------------------------------A ------------------------------ <br /> - - -•------------ __ �a=---'-------------- - --i------'-`- - -- t-----•' -"-- ------- `---'•----'" :"- . <br /> (Draw existing and required addition on reverse side) - 1 <br /> f 1 hereby certify that I have prepared this °pplication and that the work will be done in accords i e. with San Joaquin <br /> 1 County Ordinances, State Laws, and Rule's and Regulations of the San Joaquin Local Health District. Home owner or liven- <br /> ] sed agents Signa re certifies the following: # . <br /> "I certif hat i the p rformance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to be a ubi o Workman' Compensation laws of California." <br /> Signed. ------- - - ---.--- -:----------------- --------%------- ----- Owner <br /> BY ` �_ -�_, Title = <br /> -- <br /> If• �.- <br /> =,- k-1 T VQ <br /> -FOR-DEPARTMENT-USE`ONLY �--- - p-- - <br /> APPLICATION ACCEPTED BY --�f.-1 - '-------------------------------------- ----------------------------------- DATE ----- ---- <br /> BUILDING-PERMIT-'ISSUED - DATE----------- r---___ <br /> ADDITIONAL COMMENTS -- -r_ _--.- - ,.ti ---- <br /> --- - -- ------ - <br /> - <br /> ----------- - <br /> rwT <br /> R E � \ �T r r � <br /> ---------- - --- - <br /> -------------------•------------------- �----�-Z.�---�' -- --------- �-------------------------------- -- - --------------------------------- <br /> Final ------- <br /> -- ----- <br /> Inspectionby: ------------------------ ----------------------------------------------------------------------------------------- Date ------------------------ -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M 1W - ,r <br /> f - <br />