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�- n- — V <br /> r <br /> FOR OFFICE use: APPLICATION FOR SANITATION PERMIT <br /> - Permit No: -�-Z-=-�--�--�. <br /> - -i {Complete in Triplicate) <br /> ' Date issued <br /> • ----- ` f <br /> This Permit Ex fres Y Year From Date Issue <br /> - <br /> ----------=-PP--------- ----------- <br /> n <br /> Application is hereby made to the San Joaquin <br /> liars Local <br /> Counealth btytordinance Nom549 and existing Rulesand talndhe work Regulatonsrem <br /> described. This application is made in compliance 3 ` <br /> : r CENSUS TRACT - <br /> JOB ADDRESS/LOCATION ---(Q 3- ---- - - 4 . - - ---•-- <br /> ;i . ------------- -------Phone --- ------- <br /> . GR,-�- _P_ ----------------------- V.------ - <br /> Owners Name - - ---------------•-----•-•-----• <br /> Address ------ <br /> - .C� �itv . 'ft <br /> Contractar's Name r- "A`'�5 - .. ----- - .License # _ t l- Phone - .-- <br /> i i, , , r <br /> installation will.serve: Residence Apartment House❑ Commercial :❑T filer Court ❑ ^r <br /> ' Motel ❑Other ----------------------- " --- ------•--�' • <br /> +rt <br /> Number of living units:: <br /> B Number of bedrooms __ _=#v Garbage Grinder -/k)a__ Lot Size __ - ---- - - - <br /> >- � � _ Private <br /> Water Supply: Public destem and name ---- -- V -------------------- -- ---- ---------------------------- - <br /> Character of soil to pth of 3 feet: Sand'❑ Silt❑ Clay ❑. ,•Peat❑ San"dyoam ❑ Clay Loam <br /> PP Y <br /> st' + 1f y e ---------------------------- <br /> Hardpan Adobe ill Material ----- r.- - es, type <br /> R <br /> {Phot plan, showing size of lot, locat of ystem�inxrelatio oto, e b )dings:etc. must be placed on reverse: si e. <br /> ermined Pif public sewer§is available within 200 feet,) <br /> NEW INSTALLATION: 1(No septic tank or seepage pit,.p� i bl F 6 <br /> �'i+ ------- Liquid Depth --------------- --------- 1 <br /> PACKAGE TREATMENT [ ] SEPTIC�TANKT ] +`` • '� Size---- ------ -.----•------- <br /> - <br /> FV <br /> - -. No. Compartments ------•---- •----_.... <br /> Capacity _ Type'"_- _-------�' Material__ <br /> P Y a - Fo ' <br /> i ,L Prop. Line S <br /> ne urtidation <br /> Distance to nearest: <br /> Well _-__�-- f <br /> . - = ------ Total Length ------ -- ----- <br /> t - � �.` � Length of eac4it,line-_'_'_-- _ - g <br /> LEACHING LINE [ ] No. of Lines' -------------- ---- - <br /> Ii -- - e fih Filter Material ------------ --------------- <br /> i 'D' Box TYPe Filter Material` , P ; A <br /> II` Distance to nearest: Wel! _*___,----- -- Foundation --- ""- -------- Property 1Line _------•----,--- <br /> ` _ --- &tock filled Yes ❑ ;No �❑ <br /> ----- -- ------ <br /> SEEPAGE Diameter +1+lumber \ <br /> � Depth ----------- --- -. t 1 <br /> SEEPAGE PIT ) Water Table Depth '----- --------Rock Size ---------k-=------- -•-------- <br /> r------------------- <br /> 'WPr Line -... <br /> Distance to nearest: We11 ----------------- - -_._ '�`'4-foundation -------------------- ©P <br /> --- <br /> , ►AiR/AOOITION(Prey. $anitation,Permit#---------- ----- , r <br /> ' ---" �. ----------------_--•-.-- __---_•.---.'•_---•--•-----_-� �------- ------? <br /> Septic Tank (Specjfy Requirements) -.-- ------------------------- ar <br /> L ------------------�1Q_2 !_l�l-----`- FT"' -�j = -�----p <br /> Disposal Field (Specify Requirements)-_44 -- - I <br /> . . . . :� <br /> --- <br /> -------------------------------------- <br /> ----- ---- - <br /> i (Draw existing and required addition on reverse side)-.�.. . <br /> I hereby certify that hllhave prepared this Opplicbtion 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. Horne owner or liters <br /> sed agents signature certifies the following: r. <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 u 'ect to WLoArkr��fs'an'ss C,ornp�ensati.on laws of California." <br /> Signed (�.1�13 � -'�°------------"' ------ ------------ ----------- Owner <br /> --------.-4 .---__-- <br /> f-I'l lel `---- ---- Title ------ ` <br /> -- <br /> (If other lithan owner) <br /> li FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED -- , <br /> TED BY ./�------------------------- - -------------------------- ----- DATE ------- ---- <br /> BUILDING PERMIT ISSUED ------------------------------ <br /> -------- --------- ------------ --- ---- -- DATE --------------------------------------------- <br /> BUILDING <br /> --- ------------------- -;------------- <br /> ADDITIONALCOMMENTS --------------------------------------------------------------------------- ----------- ------------------------------------------=----- <br /> ------------------------------- <br /> ----------------------=----------- <br /> ----------------------------------:----------------- -------------------------------------------------------------------------------- <br /> -- -- ------------------------------------- <br /> ------------------- -- <br /> -- ------ ----- ---- <br /> �`� � - - ----- --------- --------- ----Date -------- --------- ----�- - - <br /> Final Inspection b = ------ ----- ------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />