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f FOR OFFICE USE: <br /> APPLICATION FOR SANITATION -PqERMTT 4 <br /> : . � �. ,��v.� . `T Pei•rrtit No. �3= V7 <br /> . .. - <br /> {Complete in Triplicate) .._........ <br /> .......................... ...... <br /> This Permit Expires i Year From Date Issued Date Issued 11.1�' <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 Regulations- <br /> ! o / .� _ 1 <br /> JOB ADDRESS/LOCATION .... ....._`.... .__L!�KFrr�`' ._.. cs�' f�/$p +e�y iSCENSUS TRACT .------•-.•............... <br /> Owners Name ....... ........................•-------.!...................Phone .:S(G�.-.7,1%5...... <br /> Address ..._....�'J5_...C90.--.. .' U��-G�.t. U.— ------------ --- ------ City _.�Q �-y,6t4.-- <br /> . ...:............. <br /> Contractor's Name .b A _ 6 _--..License # ... Phone ._�5'?AP.7........ <br /> Installation will serve: Residence jKApartment House❑ Commerce I^❑Trailer-Court :❑ <br /> Motel [] Other ................. .................. <br /> ........ <br /> Number of living units:_....I_- Number of bedrooms <br /> s• _ .__ <br /> -- Garbage-Grinder ............ Lot Size ....d�~...�c �� <br /> ' .............. <br /> Water Supply: Public System and name -•--------------------------•--...----- ...........___.................... Private <br /> �t <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat E] Sandy Loom ❑ Clay Loa <br /> Hardpan p [D Ad Fill Material .M....._...- If Yes, type ............................ <br /> {Plot plan, showing size of lot, location of system 4n relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seee geld pit permitted if public sewer is available within 200 feet,) <br /> a, <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size-----•-.'7s7�.. ............. Liquid Depth .......... ..l........ <br /> l Capacity .lv Oq. .. Type. w-, _ Material -� +- No. Compartments o�-------_••--•._I 'f <br /> DistanceJto-'1''nearest: ellD-�_ I-;aundation ... i. .... Prop. Line ate._....'�----.�' <br /> LEACHING LINE No. of Lines *. . '.} Length of each line......JP�7b.'......... Total Length ...r.�-Q e............ <br /> D' Box ...._ Type Filter Material _�O_C _____Depth f=ilter Material ...... .' ........... <br /> ................. .. <br /> ill Distance to nearest: Well --- Foundation .�B r_ .......... Property Line �'�a_ .......0 <br /> SEEPAGE PIT ) Depth ..ate.`.._....; Diameter .. ---- Number ..... .................... Roc Filled Yes � No <br /> Water Table Depth <br /> ..-.��b.......... <br /> . Rock Size <br /> .._Ifs'. . . ........ , <br /> Distance to nearest: Weil ..__/0'?.�------------------------Foundation .-.rP.r..`fT.... Prop. Line .... ... .. � <br /> REPAIR/ADDITION(Prev. Sanitation Permit1W-----------------------------------.__,----- Date ---------------------------------- <br /> `Septic Tank {Specify Requirements} .. f -----------------------------------------------•----------...-----------•---._............._._...- <br /> Disposal Field (Specify Requirements)j t----------------- ----­--­------ ------- ------------- ................. ._..---------...--- ............... <br /> ----------- -------- -------------------- --------------- - -- ------- ----------------- ................................ <br /> ------ .................. 3---- -- ---- ------.------------- ............ .......................... ..... -----------•------- ... ....... <br /> !; (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 /> CaYnty Ordinances, State laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licen- <br /> sed agents signature certifies the fallowing:` , <br /> "1 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 Workman's Compensation laws of California." <br /> Signed .... '------I....................- Own:11&� <br /> BY: ... _. . 01". - - 'iL7. .. .'. _- --...... Title ... ..... ....... -------- <br /> k If other than owner) i �� <br /> ( <br /> .r I <br /> —-- I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ._. ....... ...... DATE _....�.�-�,-,'13................. <br /> BUILDINGPERMIT ISSUED .- - -�- ----......... ._.....----... ..-=---------•-----...--. ..... ..............DATE . ........................................ <br /> ADDITIONAL COMMENTS ................... ............. <br /> .EF f <br /> ........................................................ <br /> ................. <br /> ... <br /> --------------------------------- <br /> ....--------- <br /> ......._._..-----._....---. ........ ........... .. ... .. ........ <br /> ...,.. _ .. <br /> ....E.................... ------------- ----------- ------------ <br /> Final Inspection by- --- ----- -- - -------- '.. pate ._...� ". S � <br /> �FSANIJOAQUIN LOCAL HEALTH DISTRICT n <br /> c u 13 24 , .An n_-_ r.. <br />