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r <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> i (Complete in Triplicate) Permit No. 7y-.�b.... <br /> )............. Date Issued <br /> '............................:........................... i This Pe'i, it Expires Y or-From Data Issued ' <br /> Application is,hereby made to the San Joaquin Local Health District for a permit to construct and install the ark herein <br /> described, This application is made in compliance with aunty Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRE55/LOe~ATiON ......./.. j�.�.. ��.Q./.,.f................. - .CENSUS TRACT ._....... <br /> Owne_r`'s Name "_�...:..� Q'G --<'./ -�r!!Iz ---------- ------ -------Phone __._..............._ <br /> Address .:.:... : ". .. .`�7.. !v.. •� 1g�--........ --•.•. --... City <br /> ContractoPs'Name �.--. .O.O_... - �... License # ��,/� 1�- Phone"�l . <br /> Instal lati;4rjlI serve, r Residence Apartment House-E] Commercial ❑Trailer Court C)Mot I ❑ Other --- - <br /> r Number of living units-,­1"'. Number of bedrooms __...Garbage Grinder Lot Sze .0..'S......................•.... <br /> y � <br /> Water Su'p'ply:Public System and name .........................................:-.._................ ---_�---.--.------.-.--------.--.--.------------Privatef i <br /> I! <br /> Character of soil to a,depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay loam ❑ <br /> Hardpan ❑ Adobe Fill Material _,410. If yes, type ...._..................... <br /> rplot plan, showing size of lot, location of system in relation to wells, buildings, etc. must ge placed on reverse side.) <br /> I NEW INSTALLATION: (No septic tank or seepage pit'permitted if public sewer is available within 200 feet,) <br /> I PACKAGE TREATMENT [ SEPTIC TANK ---C z -..0 . <br /> -----__...._... Liquid Depth --. . .__._.....y <br /> Capacity / � _._ Typehled z_... Material ... .. o. Compartments %P <br /> Distance to nearest: Well .• ._ _.-__..............Fo�undation.. Q..`......--. Prop. Line ............J <br /> BEACHING LINE No. of Lines _ ,._. 0i .Length of each /liffe'J. �-...__ .._... Total Len�ltl4l -, �.�.--•....... <br /> `' <br /> D' Box 1 . Type filter Material r _C.�S-...Depth Filter Material ,... D ............... ...............Vy <br /> Distan to nearest 'i a __ <br /> _. .�.___.__.__. Foundation . `�..�..._.:_._ Property Line ��.....................__ <br /> SEEPAGE PIT Depth .� ! _T _;'Diarneter -. -- — <br /> { p 3 - -..:.: Number .. — -. hock Filled Yes No IV <br /> Water Table Depth .`_...:_. -----•--.-----I.................Rock Size ....)/.,.x_3._............ ` Q, <br /> Distance to nearest: Well -.-- -o_�..... .............._--Foundation _.._1_P.T._._..._ Prop. line .�..__._..........yf <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -::=----. ::_.- '-----::•----,- -- Date ----------- .......--------------•) <br /> "t. Septic Tank (Specify Requirements) .- <br /> ........................... <br /> I 1 A <br /> Disposal Field (Specify Requirements) ,.........---•._..__._............................ <br /> . <br /> -`.... .. ...................... . :.........._...........-----......... -- <br /> s <br /> (Dra'w existing and required addition on reverse side) ' <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, State laws, and Rules and Regulations of the San Joaquin Local health District.`Home owner at liven. <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 /> as to become subject to Workman's Compensation laws of California." <br /> Signed ......... --......... .. ............................ ....•----- •---•--- --- Owner <br /> ......... --•- -- .............._Title . . L. _ <br /> her than owner) <br /> FOR DEPARTMENT LIS ONLY <br /> APPLICATION ACCEPTED BY . -. /.. ..; fDATE .. •� �- <br /> BUILDING PERMIT ISSUED A.... .........__.. ... <br /> ..---�----------------- ---------•-"�--- -...- i.','.,-,.-,.-.-,,.-,--,,.---....--.._..DATE ..--- --..__...-- • ••-� -•-------.._...... <br /> ADDITIONAL COMMI:NT5 ... ........................ ... ............................. •-=---------.......__...----- <br /> --------------- f. ............ ..---... _..... --...... _... -;................ <br /> .................................•-..... ... _.: .. .... .. •---... .... <br /> Final Inspection b ----- Date ✓ <br /> i <br /> SAN J4 QUiN ICTAL ALTH DISTRICT a <br /> � y <br /> S k ' <br /> 13 24 _ csi .ea, k rte: :. .. . 7172 3 .K <br />