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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> r <br /> -------•--------------------- Permit No.��_�__� <br /> ---------------------------- - --- <br /> __. _ r. .: <br /> -(Complete in Triplicate) ­- <br /> ---------------------- <br /> ._ �. . . <br /> ---------------------------------------------- --- <br /> Date issued <br /> ----_-..-______ -------------- This Permit Expires 1 Year From Date Issued ` <br /> Application 'i-jihereby made to the Son.-Joaquin Local Health District'for a permit to construct and install the work herein <br /> described.-tkis application is mbae incompliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ION ---------6985--`Fergus--------------------------------------------------n �. .�""e' ..!--------CENSUS"-TRACT"`"-------------------------- <br /> -40 <br /> ".'- -§ - <br /> -- <br /> Owners Name A. J. Frank Phone 9 _ fl6 <br /> ---------------- ----------------------------------------- <br /> ;� <br /> Address ------------Same-------------------------- --------------------------- --------------- =. City S ock�on------------------ <br /> r .� , C ' . <br /> Contr, to-;NameBlackard's- SePticJ Ta;nk_# _ - 7_611,8.-_.:- <br /> --- License # 26.8:}51 Phone ---1j 6--.:- - . <br /> Instaliation will serve. Residence JK]Apartment House-E] Commercial ❑Trailer Court ;❑ , <br /> 's.. 1 Motel`❑Other !-------- ---------'g------------•--- + <br /> Number of livingunits:-.-.-_. Number of bedrooms '3_2_____Garbc a Grinder -_m____ Lot Size ...lj_-Aar+,_-._.--.----'--_-_--. <br /> Vin: i <br /> Water Supply: Public System and name ------------ ----- ------------------------------------------ <br /> Cho = Private ® : <br /> r racter of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> .� <br /> Hardpan E] Adobe'® Fi11'Material ----- _--- If yes,type <br /> . �/6 <br /> (Plot4an, showing size of lot, location of systemin`relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or. see page'pit-permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT [ I SEPTICTANK'f:J t-- Size------4 'X5°X10_'-------_----- ______ Liquid Depth _48............--------- <br /> Capacity 1200- ----,--- Type ---'--- Material------aemerit No. Compartments ---2........i------•-. <br /> Distance to nearest: Wel( - ._ Q°--_----- _~_=_-_.-_--.Foundation ____--iax-__._ --- Prop. Line -_10-�- :-_--_ <br /> LEACHING LINE No, of Lines ------------------------ Length of each line-----_85__---___--.--__ Total Length 1'-0__.--_-...._-_._ <br /> D' Box -----;�.... Type Filter Miaterial ---2:'_'4----------Depth Filter Material __-911--------------- -------- -------- <br /> Distance to nearest: Well ---50................ Foundation ----30-►------------- Property Line. J-0.9 ............. <br /> SEEPAGE PIT [ Depth ----25r-M--------- Diameter ---- ----_ Number ---------2----------------- Rock Filled Yes ® No <br /> Water Table Depth --------------- ------•----------------- Rock Size ----2„------------------------ # <br /> r Foundation -- a Prop. Line _-iQ-._..-?r;.._. <br /> iz r. <br /> Distance to nearest: Well -.-----140-!--------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------"''-------------- --- Date -_--_--------_-_--....__-__----_) " <br /> Septic Tank (Specify Requirements) -------- 12Q---GVk1_.___,5.eP_fiC-- Tek----------------- ------------------------------------------------ <br /> 1'�f_Q.!. _�,, <br /> - � -i- ?)----------------------- <br /> Disposal .Field (Specify Requirements) x . �acr�.-lai.3�a-_--�---2_..p-i��---�Jr X�-� <br /> ( 4' w f1 i <br /> ` (Draw existing and required oddition`on reverse side) <br /> 1 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 lic_enL <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 tofbecome subject to Workman's Compensation laws of California.” <br /> I ' . <br /> Signed ------- ------------ Owner <br /> - d <br /> t -------------------• Title �d... <br /> (If other than owner) <br /> a / DEPARTMENT USE ONLY ` <br /> APPL'iCATION ACCEPTED 8Y /{----- --- - ----------------------------- ------ ------------- DATE ------- <br /> BUILDING <br /> ----BUILDING PERMIT ISSUED - -- ------- - -- ------------- -- -----------------------------------------------------------DATE - -------------------------- - <br /> ADDi1TIONAL COMMENTS - ------ ---------------------------------------------------------•-------------•--------- ------=---------- ----- - <br /> ------------- --- ---- ------- --- - --------- ------------ <br /> -------------------------------------------------------- ---------------- ---------------------------------------------------Ly� <br /> �"''} <br /> Final:Inspection by: <br /> .✓ -,, = Date <br /> SAN JOAQUIN LOCAL,,YAEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M :� a <br />