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FOR OFFICE USE::.._ :� { <br /> M <br /> APPLICATION FOR SANITATION PERMIT <br /> .........--•---•................r., ....... to le Permit No. .7�-7/`� <br /> S <br /> mp tein Triplicate) _._ .. n_._•_.. R <br /> Date lssuecl . <br /> This Permit Expires 1 Year From Dote Issued <br /> .. <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 ismodein compliance with County Ordinance No. 5:49 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ./d. <br /> • -'T—'•2......22e,� --•�2 ........�.CAld-Vl.�NSUS TRACT <br /> Owner's .Name ._ �i.31. ,7f� JrAI. —a-17J................... Phone ...._.................._.:.......... <br /> Address ...... City <br /> Contractor's Name 0'l ?1 -------- ----.license# .._.--.._;..... ... Phone <br /> .Installation will serve: ResidenceApartment House 0 Commercial flTrailer Court C) <br /> Motel ❑Other............................................. <br /> Number of living units:... Number of bedrooms ., ......Garbagaa Grinder e{�iQ..._ Lot Size _.._ <br /> Water Supply: Public System and name ........... ---•-•............................. -- - _..........................................Private, . <br /> Character of soil too depth of 3 feet: Sand❑ Silt o Gay ❑ Peat Q Sandy Loam❑ Clay Loam' <br /> i Hardpan d� Adobe O Fill Material ............If yes,type............I.. ......... <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 /> PACKAGE TREATMENT [ ] SEPTIC TANK i Liquid Depth <br /> Size......................................... ......................... <br /> I, <br /> Capacity ---------------•-•-- Type --------......:_..._ Material---•----------- <br /> ...... No. Compartments ------- ........... ., <br /> Distance.to nearest: Well ..................................:.Foundation........................Prop. Line <br /> I LEACHING LINE [ No. of lines ----------------- Length th of each line........................ Total Length ........................... <br /> 'D' Box ............ Type Filter Material ....•--•-. <br /> ..........Depth Filter Material ..... ...............:.................. <br /> Distance to nearest. Well Foundation -- -.- Property Line � <br /> SEEPAGE PIT [ ] Depth .................... Diameter --:--:= :...:. Number .---..._..-: ."_"..."".'Rock Filled Yes 0 No 0 <br /> Water Table Depth ` <br /> ---------=----••--- Rock Size ..........._•... -----------•.. <br /> 3 <br /> Distance to nearest: Well ...."Foundation _:.--.:. Prop. Lina <br /> REPAIR/ADDITION#Prev. SanitationP rmit# _ ':' ---- ............... Date _ <br /> Septic Tank (Specify Requirements -- -- -- r-�1/Z.... -... .... .__.il d1G. ..,�1v,�,t��P�-*�- y--_---.- <br /> Disposal Field (Specify Requirements) J.I-1.G__1�_____ <br /> ---- <br /> ---•-- --- ............. .............................. <br /> ---- •-------------- ---- -----------------••---..... ............................ ..................... ............................. <br /> (Drow 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 Son Joaquin Lecal Health,District. Homs 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 bcome su ject to Wor man's ompensation laws of California." <br /> Signed <br /> _.. .----- - - - __ Owner <br /> By -•---------------- ------------------ <br /> (If <br /> ----------•-----(If other than owner) <br />! FOR RPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---.-. ...... . ..... - DATE.-.c :,.� _ <br /> .,., , <br /> BUILDING PERMIT ISSUED ........ <br /> ADDITIONALCOMMENTS _-.------•---------•----•---•-•------.k---- ----------------------------------- --------------------- <br /> -­----------------------- -----------------------•---.....--•--------•-•-- -----------•--•------•---------------------- <br /> •--------------- _...---•------..................... ........ ................. _ <br /> ••----------- ---------- ----- -- - ----- -- {� <br /> Finalinspection by: - -------... - • •----- ----- -- -- ................. ----•---- . -•-----�----------------- -.©ate ..l�.- Z�'_7_.... ------------- <br /> l3 2 1-6f3 SAN JOAQUIN CAL HEALTH DISTRICT 8/71; 3M <br />