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FOR OFFICE USE: APPLICATION .FOR' SANITATION PERMIT •, <br /> ------ ----- `% Permit No. - l. l <br /> (Complete in Triplicate) ; <br /> y q� <br /> ---------------------------------------- -------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued .6/ 'f-'u7 <br /> //J <br /> Application is hereby made to the San Joaquin Local Health District for a ;per to construct and install the work herein <br /> f 1 n, h existing Rules and Regulations: ' <br /> J <br /> described. This application s ade-in_compliance with County Ordinance No. 549 an <br /> -�JOB ADDRESS/LOCATLON CENSUS TRACT --------------•---...___-- <br /> - Owner's Name y, >,,� �� _.C. _.�._ -------- -------- Phone <br /> •rte/ . /' <br /> J --- <br /> Address ---- ---- - --� --�- --• - - ---1".�✓-�--� ----- city -=---------- ---------------- ---------------------------------------------- <br /> -'Contractor's <br /> ------------- - --- - ---- - - - - - <br /> Contractor's Name / � --------- - 8----- � - - 1� hone <br /> --------------------License 4- `� TIS -��-- <br /> r Installation will server s'- <Resi.de'&e.-❑ Apartment House❑.Commercial ❑Trailer Court '[D a 4 <br /> )Motel ❑Other <br /> Number of living units ------ Number of bedrooms . ___--Garbage Grinder --- Lot Size' _ _ ----- <br /> Water Supply: Public System and name -------- -—=-------------- =: — _ = == ==' Privates <br /> _ .x , <br /> Character of soil to a;depth-of 3 feet: ' Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 <br /> -Hardpan E] Adobe i I M _. <br /> Material If yes,type ---------------------------- <br /> m <br /> O <br /> (Plot plan, showing size of lot, focation i f system in relation to:" wells, buildings, etc. must be placed on reverse side.) r.h. <br /> �. <br /> NEW INSTALLATION:I (No septie tank o'r sese g'pit permitted if public sewer is available within 200 feet,) . <br /> PACKAGE TREATMENT ( � SEPTIC TANK:V } Size--- _ -:-=----------------•__ Liquid Depth _7_ -___-___'_-- <br /> i Capacity =--- --1 "_�__ Type _-t r� .�Materialec?,94_i- ____ No. Compartments - <br /> Distance to nearest: Well;-.----__-S--�_____ ____________Foundation _-- _1�__----_---_ Prop. Line ._��-:-_.— <br /> s / <br /> LEACHING LINE No, of Lines Length of e <br /> i ' s� <br /> ----_--:-- Len each line---/-- --�_ .Total Length , -------------- <br /> I D' Box _-,3 -I5- Type Filter Material _l/i~___lDepth Filter Material --- _-�______________________________ <br /> ! t Distance- o nearest: Wel! -_- ---------- Foundation ----/-D_ r----_--_ Property Line _- ........ <br /> SEEPAGE PIT Depth ' -, _�_____ Diameter --------- Number -----'��__ -- Rock Filled Yes �No:i❑ <br /> Water Table Depth ------------ <br /> --------- 't--- --- -------t--- ___----Rock Size _Z�z---`-�-t�------ i \ <br /> Distance to nearest: Well ------: --------------------------- ----.Foundation ___ __-_ Prop. Line P--j.............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------�--------- Date -_-_--_-._------------------------) <br /> Septic Tank (Specify Requiremerits) =------------------ ------------f=----------- ----------------------- ------------------------------ --------------------------- <br /> Disposal Field (Specify Requirements) ----------------------------------------I------------------------------------------------------ ------ ---------------•--------------- <br /> --------------------------------------------------- ---- <br /> � . <br /> - -------------------------------------------------------------------------------------------------------------------------------------------------- <br /> a , <br /> _ ' --------------------------------------------------------_---__ _ _ _ <br /> `-(Draw existing grid required addition on reverse side) E <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: A <br /> "I certify that in the performance of the work For whichthis permit is issued, 1 shall not employ any person insuch manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------- ------------------ -------------------------------------------------- Owner <br /> BY --------------- ----------------- -----------------1­ Title -------4-DL4---���:------ - ---- ------------------ <br /> (if <br /> -------- --------(If other t n caner) , <br /> FOR DEPARTMENT USE ONLY <br /> q <br /> APPLICATION ACCEPTED BY ----- = ------ --------•----: DATE -- ----- <br /> BUILDING PERMIT ISSUED ---------- - ----------- DATE ------------------------------------------ <br /> ADDITIONAL COMMENTS ----------------- <br /> ------------------------- <br /> � : <br /> -------------- ------- ---------:- ------------------------------------------------------------------------------------------------------------------------------- -,------ ----•--•- <br /> ---------------------------- ------------------------------------------------- -- -- ------------ ---- -------------------------•-- ------ <br /> -k <br /> ----- <br /> L <br /> Final Inspection bY- ----------------------------------------- - ----- Date 1 <br /> - <br /> SAN JOAQUIN LOCAL/HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />