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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ----/-71�i� - Permit No: --�------- ---------- <br /> {Complete in Triplicate) <br /> -------------------------------------------- Date issue ._.c;q___ <br /> ------------------------------ <br /> 4'4' This Permit Expires 1 Year From Date issued <br /> Apprmit to construct and <br />` <br /> described. <br /> Thishapplication <br /> pplcp on isothe made in compliance ein cal Health wi h County trict for a Ordinance No. 549 and existing Rulestalnd Regulations. <br /> described. pp <br /> 9 /� <br /> I JOB ADDRESS/LOC <br /> /�-a�--�-----�^---- 1 / 1C/ �CENSLlS TRACT -------------------------- <br /> i s �` _. <br /> Owner's Name _ f / /"= e �-rd - ` --------------- - Phone <br /> Address -------10_;L41e5 _ • • �� --------------- <br /> City -AS' <br /> �If ------------------------------------------- <br /> "� --.License #� .' Phone _. ` <br /> Contractor's Name -- - -l��Gt--.=�j�t����i*"'------- ---------- - <br /> ------------- - <br /> installation will serve: Residence Apartment House,171 Commercial ❑Trailer Court ❑ <br /> Motel ❑Other ------------------------------------------- <br /> Number of living units:-._/----- Number of bedrooms A/---_Garbage Grinder /.VC-0, Lot Size _49�!44-y--4:g!,------------- <br /> Water Supply: Public System and name ----------------------------- ------------------- --------------------------Private f� <br /> Character of soil to a depth of 3 feet: Sand'El Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,E] <br /> Hardpan ❑ 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 side.) <br /> G <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 244 feet,) or <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' Size_ Jr�r-f� - -------------------- Liquid Depth --------- <br /> Capacity TYpef-4-- Material_40-440;------- No. Compartments ---� ............. <br /> Distance to nearest: Well .___.®_ "I Foundation _Cf� --------- Prop. Line /V_--`_-_-_____ <br /> 'Pe---------------------- <br /> LINE No. of Lines -----A---------------- Length of each line __Pim----------------- Total Length -,�-__----____.____ <br /> ff <br /> D' Box Type Filter Material_ Depth Filter Material _ -Distanciy_cd,_!F <br /> tnearest: Well ------------------------ <br /> Foundation ------------------------ Property Line ___ �-- -.:---- <br /> SEEPAGE PVT Depth .__ �-------- Diameter -__--- Number -- ------_ -- Rock Filled Yes No .Pp <br /> Z <br /> ss �. <br /> Water Table Depth ----&�_-11- ----------------- ------------Rock Size 1 "' ------------ <br /> Distance <br /> -- -Distance to nearest: Well ---X'_JP_0-----------------------Foundation ---415�p--------- Prop. Line ---Z,?---_------ <br /> ( REPAIR/ADDITION(Prev. Sanitation Permit# --- ----------------------------------- Date _---------------------------------) <br /> Septic Tank (Specify Requirements) -------- ------------------ --'--------------------­- ---------------------------- <br /> Disposal Field (Specify Requirements) ----------------------------------------'--------------------------- -------------------------------------------------------------- <br /> a ------------------------------ <br /> ------ -- -_ <br /> (Draw existing and required addition on reverse side) <br /> k I hereby certify that I have prepared this application and that the work will be doneAn 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 not employ any person in such manner <br /> i <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------------- ---- --- w Owner <br /> - ------------------------- ---- <br /> Title ------ 1-116 ' <br /> (If of t an owner) <br /> FOR .DEPAitTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------------------------ - --------------------------------------- DATE <br /> lZ 1z -- ------ <br /> BUILDING PERMIT ISSUED -------------------------- ------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS --------------------- --- <br /> ----------- <br /> -------------------------------------------------------------- -------- ---- - ------------ <br /> --Date : _1.7 <br /> ---------------- -------------------------------- ------------------------------------------------- <br /> - --------------------------------------------- <br /> ----- --- ---- ---------------------------------- - - ---- ------- <br /> ----------- <br /> $ ------------- --- --------- <br /> ------ - - - - ---- -- -------------- <br /> Final Inspection by- ----- --------� -----' -- - -------- ------------•------- - ----- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br />