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FOR OFFICE USE: <br /> -5TV <br /> A��I.ICATION FOR?.�SANITATION PERMIT <br /> 1. A----------- <br /> �� � -[Complete in Triplicate( -P 7� <br /> -------------- ---------- --------------- --- . <br /> �-� .�j� ,Date Issued �"lp,�- <br /> Zq <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 /> described Thisva•p�cation is made in compliance with'County Ordinance No.X549 and existing Rules and Regulations: <br /> t c, <br /> JOB ADDRl;gS;{I`OCATION --�--��_L"_------ --sem-- -G�``--�'s --- ----- ---- -CENSUSTRACT -------------- ----------- <br /> cc ` <br /> Owner's Name _ f_"_fes/ d=- J-f• ( -------------� -- ---'�-- ---- ' � - on'e ---------------- ----------------- ' <br /> -. `'Ph <br /> Address `�� ----------------------------------- i <br /> ----- <br /> City <br /> Contractor's Name ----= t / M' '�% .-= ---------------- License #� �. Ph'one �� <br /> Installation will serve: Residence A<Partment cruse,E] Commercial ❑Trailer Court I❑ 1 . <br /> Motel ❑Other ----------- t <br /> Number of living units.- ---- Number of bedroom.------Garbage Grinder 1_ L'ot Size 'i_ v _ __� .Q--- r <br /> Water Supply: Public System and name ___ 407_ „fr'---------------- Private ❑ <br /> ,_. <br /> Character of soil to a depth-of-3 feet..-Sand''❑ ' "Silt[]""-"'Ctn�L6 � e' ❑ Sandy Loam`R❑ i Clay Loam <br /> i I <br /> ] Hardpan E] Adobe ❑ Fill Material;_-_.___---- If yes,--type --"'.__._________________ <br /> t <br /> (Plot plan, showing size; of lot, location of system`y in;relation to wells, buildings, etcs must be placed on reverse side.) ; <br /> NEW INSTALLATION: lNo septic tank or seepage`p'it�ermitted if p6blic -sew er :ia ,] <br /> available wAin`200-filett <br /> PACKAGE TREATMENT []..-�SEPTIG�ANK•[-]- ._._.....Size-----=_------------------- ------------------- .Liquid Depth >== ------------ --------- <br /> , <br /> CapacitY Type -------------------- Material '. No., Comprtments ------ ------ -------- <br /> t. <br /> Distance to nearest: Well Length•--- ----------------- <br /> - ------ -----Foundation------------------i_'.Prop. Line -_------------------- <br /> LEACHING LINE [ ] No. of Lines ----------.----------- each line--------f------------------- Total Length -- -;-.---.------------•---- <br /> 'D' Box ------------ Type Filter Material _i -------------Depth Filter Material -_-----------------------..-----------•- <br /> 'Distance to nearest: Well ------------------------ Foundation ------ --------- --- Property Line -----------..----- , <br /> umb°e ° Rock Filled Yes No <br /> SEEPAGE PIT [ ] Depth -------- _.____-___ Diameter N , ❑ <br /> WaterTable Depth ------------------------------------------------Rocosize -------------------------------- <br /> Distance to nearest: Well -------------------------------- -----F G anon ---- --------- Prop. Line + <br /> � t <br /> REPAIR/AD61TION(Prev. Sanitation Permit L# -----------------------------•-------------- DateJ-------------------------------} � <br /> _._ _._. --------- <br /> ¢Septic Tank (Speafy, Requ��emet�ts).�..---------- -- ---- - -------------- --�----------- �"---------; o- -------------.-- ---- <br /> _ fl w-- <br /> xDisposal Field (Specify Requirements) -- _ ,. <br /> { <br /> -- - _- ------------------- <br /> --- <br /> + ----------------------- ------- <br /> ------------------------------------ <br /> ----------- -- -- - ------------------------------------- t <br /> (Draw existing and required addition on reverse side] <br /> A T <br /> I hereby certify that C have prepared this application and that the work will be done lin accordance with San Joaquin <br /> County Ordinances, State»L•aws,.and-Rules and Regulations-o.fwthe:San:JoaquiwLocal.-Health District. Homeowner or licen- <br /> sed agents signature certifies the following: ', <br /> "I certify that in the p"rformance of thework�for which this,permit is'issued, I shall not employ any person in such manner <br /> as to become subject tv Workman's Compensa laws oft4lalifornia." <br /> Signed ----- ------------------- - - '---------------- -------- -------------- ------------ Owner <br /> BY - --------- ----------- Title - ------------------------------------ <br /> ---- <br /> - <br /> (If oth an owner} ,..- -..�..w,....`� , _ _ y f: ,� <br /> '� FO EPARTMI NT USE ONI.i <br /> APPLICATION ACCEPTED BY ------ - --------=----------------------------- --------------- DATE _._ ------ <br /> 7.?)--------- <br /> BUILDING PERMIT ISSUED ---,�'---------- ---- ---------- =-=-- -----'-------DATE -- -'` <br /> ADDITIONAL COMMENTS ! -' 1 - =- _ ' ' �; -------------- <br /> 5 'f --------------------- - <br /> v� <br /> . 1 <br /> ' ' ------------------------ x --- ---------------- <br /> --------'---- -------------------- '�-�z.� _ t.lV > , <br /> i- <br /> Final Inspection b ��_� 0+tI- ---------------- ---- ----------- -------- - -------------- <br /> SAN <br /> ---- --------SAN JOAQUIN",LOCAL HEALTH DISTRICT <br /> E. H 9 F ., -'68� 75M <br />