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FOR OFFICE USE: <br /> j APPLICATION FOR SANITATION PERMIT <br /> ------------------------ -------- - - - f Permit No. <br /> (Complete in Triplicate) <br /> _______________ This Permit Expires 1 Year From Date Issued 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 with County Ordinance No. 549-and existing Rules and Re ulotions: <br /> JOB ADDRESS/LOCATION &G er ti -Fr_ za�h camp --CENSUS: TIZACT` ' <br /> Owner's Name ------ Phone.,'- "" .• <br /> --- --•--. Cit$'1tockton--------- . t: -- . , <br /> Address --4-5.5---No...... Llx�[�A----- -------------------------------- -- - - -'----=--'- =--------------------------- ' <br /> • { .epi r. <br /> Contractor's Name .B1aakar-d°s---------- -------------------•-----------------------------License # ?095 �_,_-. Phone 463_?t7.048--------- <br /> Installation will serve. Residence ❑ Apartment House❑ Commercial ❑Trailer Court R] <br /> Motel ❑Others ` , �- - _ - � "r.. C° i <br /> -------------- <br /> Number of living units_____________ Number of bedrooms ____________Garbage Grinder -- '__-___- Lot Size:____ _ o �____.K�:r <br /> .�, Z - <br /> Water Supply: Pu=blic-Systemgand no - -------------------------- <br /> --- --------",-'" —---------------------------------------=------%ivate EE <br /> I <br /> Character of soil to a,depth of 3 feet: Sand'❑ Silt❑ Clay '[I—Pedt❑""Sandy Loam jE]r` Clay Loam:❑ <br /> Hardpan.❑,F.Adobe ❑ {r Fjll.Material ------------.If yes,type -- ------------------------- <br /> t.., 3 , s , r E <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. muse�be placed on reverse side.) 0(1 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if- ublic`sewer is-available Within 200 feet,) <br /> f-p. 0 <br /> PACKAGE TREATMENT SEPTIC TA-N-K'E Size--------------------_-.-_- - - - FLiq <br /> uid vDepth --- <br /> i mCapacity ------ -- - -"TYPe ---- No. Cartments _______________ <br /> - Foundation Distance to nearest: Well _--------------------------------- - on _._____________•___-._ Prop. Line ------- <br /> ------------------ � ---••-:----•-•- v <br /> :---__�:. '-' <br /> LEACHING LINE [-] No. of Lines` ._-_ -t:engthrof-each-line.--__---'_._____.______ Total Length -__.---------------- . <br /> `D' Box ------- Type Filter Materia.l--------------------Depth Filter Material ---------------------•-:----`-------------_.- <br /> .c:: Distance to nearest: Well _____r_ Foundat.ion .______--___-- Property Line � r <br /> � � nY <br /> ,%E4 AG -PIT [ ] Depth -------------------- Diamete��'-` - ---- -- Number ---------------------------- Rock Filled --Yes ❑ No i❑f <br /> Water Table Depth ------------- -------Rock Size --------------------------------� <br /> Distance to nearest: Well ------- --------------------Foundation _____.__-________ Prop: Line .................. <br /> REPAI ADDITIO Prev. Sanitation Permit# ______________�-------------------------- "­ ' <br /> --Date------ —-------------- --___-_--_-_- <br /> SepticTank (Specify Requirements) ---- --------------------------------------------- -----------------------I------------------------1-11- -------------------------- <br /> F Disposal Field (Specify Requirements)­:_2 &--1xa- 1s---- -eep------ y <br /> -----------------------------------------------$9---hooked._---to`-eXt,. 11-nes----------------------------------------------I------Fy------------------------------------•----- <br /> ---------------------- - - - - <br /> f <br /> (Drawexisting arid required pddifion 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. Homeowner or licen- <br /> sed agents signature certifies the following: <br /> "I certifythat in the ° - -M <br /> performance of the work for.which this permit is issued, 1 shall not employ any`p'erson in-such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ----------- ------------------------ - _ -Owner-- <br /> - ' <br /> - ..- . .: <br /> � �r <br /> BY ----- --------' -- Title t� �.. <br /> ----------- ------- ---------------------- t <br /> (If other than owner) A -,'srl u, 16 # <br /> FOR DEPARTMENT-WE.-ONLY F ' <br /> APPLICATION ACCEPTED BY ------- --- - - ;-------------- " „ - •DATE-_.__ ` _3��_ _ —,_- - <br /> : <br /> BUILDING PERMIT ISSUED ------------------------------------------------------------= � ��--- -------- ---- --------------- --------------DATE - ` ----•------------------- <br /> ADDITIONAL COMMSNTS -:--- �-------- ~____----__:----, -:_- i <br /> --------------- <br /> ----------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- --------------- <br /> - --r------------------------------ -----­­--------------- -------------------- <br /> ----- ------------------------- ----- <br /> Inspection b . r <br /> ( p - <br /> Final Ins Y <br /> 4 ;4 = Date - --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> • <br /> E. H. 9 1-'68 Rev. 5M <br />