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FOR OFFICE use:: <br /> APPLICATION FOR SANITATION PERMIT a <br /> .................I.........• .....---.._................ 6 -�"�• ... <br /> (Complete In Triplicate) <br /> Permit No::: ............. <br /> ..........I......•... ............................... Date Issued ..7 <br /> ..............................................I This Permit Expires 1 Year From Date 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 application Is made in//compliance <br /> �,,with County Ordinance No. 544 and existing Rules and Regulations: <br /> JOB ADDRESSAOCATION .-_.1..�_.�....Q..fy....... !!:...../ .1�!�] �� ......._..................CENSUS TRACT .......................... <br /> = <br /> Owner's Name _..F!eh...._....�.__._ ��a!�. L&..._r....................... .....................................Phone <br /> Address .............S"f_-'2-r........ •---•----.—City ............................................... <br /> ......._... <br />` Contractor's Name ...... ......License . Phone <br /> Installation will serve: Residence"artment House 1] Commercial❑Trailer Court ] <br /> Motel ❑Other...............•-..............._.. ..--.... <br /> Number of living units:_... J _ Number of bedrooms .....Garbage Grinder fib' Lot Size <br /> Water Supply: Public System and name .....141;nLl. ... ..........................................................._.........Private <br /> Character of soil to a depth of 3 fest. Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam p Clay Loam ❑ �\ <br /> Hardpan!JJ' Adobe}Fill Material ............ If yes,type ... <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse slde.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size................................................ Liquid Depth .......................... <br /> CapacityType ... Material----------------- - No. Compartments <br /> Distance. to nearest: Well ------------------------------------Foundation ...................... Prop. Line ... <br /> j LEACHING LINE ( ] No. of Lines ......... ........... Length of each line......... -.0.......... Total Length ....7-1_6................ <br /> ©' Bax ..../_..... Type Filter Material ....���V�Depth Filter Material ............................................ <br /> Distance to nearest: Well _.c a_........... Foundation _1.q: Property Line ......... <br /> SEEPAGE PIT [ ) Depth __._�s/___. Diameter 3. ..`J..._._ Number ..._.D. ..._._...... Rock Filled Yes �No o <br /> WaterTable Depth ....................-........................_..Rock Size ............. .................. <br /> Distance to nearest: Well .-/ _ .Foundation Zd _ Prop. Line AL............. <br /> REPAIR/ADDITION(Prey. Sanitation Permit r# ........... ................................ Date ___.-------........................ <br /> ) <br /> Septic Tank (Specify Requirements) ----------------- <br /> Disposal Field (Specify Requirements) ._._�� f.... ..... ---- 1 ................................. --------- --------------------- ....... <br />'r --------------• ------------------------------------ .........•-................................................................................................. <br /> E <br /> -----------------------------------------------.-----------------------------------------------------•-------•••................... ------------------------------------ <br /> .._............. <br /> ............. <br /> ........ <br /> (Draw existing and required addition on reverse side) <br /> f I hereby certify that 1 have prepared this application and that the work will bi 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: <br /> "I certify that in the performance of the work for which this permit is issued, I shall net employ any person in such manner <br /> as to bec a suble to km=spensation laws of California." <br /> Signed Owner <br /> By ------------------_---------- - .-•--- Title ......... ------ ... ......................................... <br /> (if other than owner) <br />, <br /> FOR DEPARTMENY USE ONLY <br /> APPLICATION ACCEPTED BY .._-.C.--------d--Y----- -`p- --------------------- DATE x. /3, ..2 ---------------- <br /> BUILDINGPERMIT ISSUED --------------------------------------- . ... ----•---••-_... -•---•------------.....--_------------..DATE -----.._._._... ............... <br /> ADDITIONAL COMMENTS ------------- ------- <br /> --------------- <br /> ........... ........--------------------------------- --------------------------------------•------------- ...... •4�� <br /> ----------------•--- -.._..--•- <br /> i final Inspection b Date ................ <br /> Py- ---------------••-�'-• .--.._--.---------- -•--..._ <br /> EH 13 2h 1-68 Heves 5m- A JOAQUIN LOCAL HEALTH DISTRICT 8/7hi 3M <br />