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OFFICE USE: ' <br /> aPPr.IcarroN FOR 'SANITATION PERMIT <br /> iCamplete In Triplicate) <br /> Permit No.'.._ ......... � <br /> This Permit Expires 1 Year from Date Issued �� Issued ...l.�.-----•---• k <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin <br /> described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulationsc <br /> JOB ADDRESS/LOCATION. ......A.....��--,.......�7T...... .............................CENSUS TRACT ......... . <br /> Owner's Name,.. {� M.r�x .......................................... .,. _ ...... ........................... Phone ..'5�1.�1�-.I 1.5----• <br /> Address . .1..6.E...... ie!........i�,C,1.r'���'.!Y......::.�,Uf1l!.......................City ..,.��_�. - . /.-ate%---- <br /> Contractor's Name ----..........(J..�_ayL .. �, ., � ................................... <br /> ••--••............:...........................License ........_:......::_..... Phone <br /> Installation will serve: Residence®Apartment House Ij Commercial❑Trailer Court 0 <br /> Motel ❑Other ................................ _ <br /> Number of living units-1...... Numb4i of bedrooms _-0.....Garbage Grinder :_.Alia.. Lot ...o.... ...... <br /> Water Supply: Public Systems and name --jL4 A 1 if.. . .................................Private Q <br /> t <br /> Character of soil to a depth of 3 feet: Sand d Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam D <br /> Hardpan Q , Adobe Fill Mater€al ...-_,...... If yes,type.....—.1..... ............ <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 tonic or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK fj Size........:- Liquid Depth <br /> ........................... <br /> Capacity :.TYI� Material Aa_11.c2e_.t-_ No. Compartments ..:.z............. .f <br /> Distance.to nearest: Well .......................•--;.........foundation ..............i.. Prop, Line ......................� <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line.........................._-. Total Length ............................ <br /> 'D' Box .......:..... Type Filter Material .. . ...........Depth .Filter Material ............................. ............. <br /> Distance to nearest: Well ..................°._ Foundation .._........:............ Property Line ........................ <br /> , Y " <br /> SEEPAGE PIT <br /> [ ) Dept): A-�------- Diameter --- ----------- Number .......°.................. Rock Filled. Yes Q--' No Q <br /> a Water Table Depth Rock Size o...................... <br /> r f� <br /> .... .Foundation .../...... . ...........PropLine ... <br /> Distance to nearest: Well ....:../.Ya. � . .... r <br /> REPAIR ADDITION(Prev. Sanitation Permit# :......:........ Date ..........:........................I <br /> Septic Tank (Specify.Requirements) ...........r........ ....-::.Z.............................................:................................................................� s <br /> Disposal Field (Specify Requirements) `•.. ,E J¢ .: ------- i.4.........-ro........ W. ......... <br /> t <br /> --------------------••---------------•----------- <br /> ----- -----•-----..-_........- .-.......-......... ........................:................-............................:............ <br /> (Draw 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 or licen- <br /> sed agents signature certifies the following: I <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 becomes a #=Work om s-�tion laws of California." ,E <br /> Signe �-- = `...--•-- Owner i <br /> By ......................................................•-----'---------------------------------.....---- Sitle -------------- ��. _------•--- ....... <br /> If other than owner) <br /> R PART ENT USE ONLY <br /> APPLICATION ACCEPTED BY ---- <br /> ------------­------------ ------- DATE /... zJ,���-................. � <br /> BUILDING PERMIT ISSUED ........... --- •-•--------------•-----.....-_.._..---...---•--...-- -------DATE --------- ................ ; <br /> ADDITIONAL COMMENTS ----------- -------------------------•----........ i <br /> -----------------------•- ----- -- - . ------ ---------.._..---------- ...._..-----------._...._ . _.__..........._.....------•--... ................................ <br /> •------- . <br /> Fin" inspection by;,-- _-�- - Date a ....................... <br /> FSI 13 2h 1-613 - Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />