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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. . �'l J 73 <br /> {Complete in friplicatel <br /> k......... .......... .---.---- yo 7V_ Date }slued ......:...........7.. <br /> 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 /> l described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> i JOB ADDRESS/LOCATIO /_/-/f.. ...... CENSl15 TRACT .. <br /> Owner's Name ...... -- - - -- -- - -- ---- •------ ..................,_...---........ /i'�_...---...-- .......I............................ <br /> Phone <br /> Address ' A ....... .... --------. City ..---._.. . :_........ <br /> ... .-----.License <br /> # -/. --- ..YPhone .......---.._.._.............. <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court [] <br /> Motel ❑Other ....... <br /> Number of living units:-...../_.... Number of bedrooms .y`.___-Garbage Grinder ._..._ ..... <br /> Lot Size _..��'"' . `-...... <br /> Water Supply: Public System and name ----....`----------------------------------------------•............._ —---------...._......- ... ..........Private <br /> i Character of soil to a depth of 3 feet: Sandn Silt E] Clay C] Peat El Sandy Loam E] Clay Loam ❑ <br /> I. 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 /> NEW INSTALLATION: (No septic tank or se age pit permitted if ublic sewer is available within 200 feet,} <br /> PACKAGE TREATMENT [ I SEPTIC TANK RSize. l _�/ .�_aC- .�_.._ Liquid Depth ......!e�............. J <br /> Capacity Typed--- Material. --- .--. - o. Compartments .......... N <br /> ` . ... �.1.._-.- ----- Foundation ... <br /> 00 Prop. Line ...$.-�........ S <br /> to nearest: Wel!LEACHING LINE [/Distance <br /> No. of Lines ._ �... . _ Length of each line ._: .1'd..�.._....... Total Length ...-- g eJ.. ........ <br /> 1410 <br /> � 'D' Box . . Type Filter Material ......-•- _-- -----Depth Fitter Material ............................ <br /> Distance to nearest:.RWeil _._...__ , _ Property-. f=oundation �.. per Line ,' .--.._ -.....-•-•-- Z <br /> SEEPAGE PIT [ Depth Z- -Diameter...__ Number ..._.. . .. _.....__ Rock Filled Yes No <br /> 01� <br /> Water Table Depth _.._... ........... . ....Rock Size <br /> Distance to nearest: Well ..,__.__�.i 0---._-_----._-_-•__Foundation _.,�d- --..- Prop. Line .� ......_........� <br /> a <br /> REPAIR/ADDITION(.Prev. Sanitation Permit# ---------- --- ------•----------- Date ----------------------------- <br /> -----) <br /> Septic Tank (Specify Requirements) . ------ •------- -•----•- ----------------------------•----. --- --------- ........ ............ <br /> Disposal Field (Specify Requirements) ---- ---------------•---------------------. ---------------- .......... ............... ........................ <br /> ---- -----•--------------- <br /> ------------• ... <br /> ......... ....... ... ................... _ <br /> _....... _..... ........_.. ._..----._. __....----------------- - - ----- <br /> G (Draw existing and required addition 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. Home owner at 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 /> as to become subject to Warkman's Compensation laws of California." <br /> • <br /> Sig � ------ -•- ------------ Owner <br /> i ned .... ...._.._....... ..._.. ._._..-- ,----- � <br /> By ........ -------­---d- Title . ..... .. .. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY ri <br /> APPLICATION ACCEPTED BY ...__. ...- .. DATE ..... `.. ..�: ...... <br /> BUILDING PERMIT ISSUED _..... ...-- --..-.- .---- DATE _........ <br /> ,may ._. ......... . ........--•----... <br /> ADDITIONAL COMMENTS _.X113/Z.�....7i'.i ...dlG._ -✓ ..i :/ Y ................ <br /> ...... _... ...............------... ....... <br /> ._.........._ ... - ._..Date.............. . ..j ._.?. ----...I.._._. <br /> . <br /> FinalInspection by: ...._-------- '-- -------...------•---•-- •-----------------...-----•--... .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />