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FOR OTFICE GSE: <br /> APPLICATION FOR SANITATION PERMIT M <br /> - ---- ------ (Complete in Triplicate) Permit No: <br /> s Permit Expires I Year From Date Issued <br /> - ----------------------------------------------------- ThiDate issued <br /> Application is hereby made to the San Joaquin Local Health District for a <br /> permit to construct and desc lbed. This application is made in compliance with County Or inance No. 549 and existing Rules tand tRegulationshe work rein <br /> JOB ADDRESS/LOCAT ON -- <br /> . .� _ <br /> 9 --- --------- ------CENSUS TRACT `7 <br /> Owner's Name _ ---------- I.LC F�/ � ------- ------ <br /> Address -- ----- � -s �. � ! ---------- -Phone d_. - � <br /> 7 - • C it ,6J 6-7�4-- <br /> ---•-- v <br /> Contractor's Name --- - ----- - - -------------•------•---------------------•----- <br /> I <br /> "-;License �p <br /> installation will serve: Residence ❑Apartment House,❑ Commercial: Phonea����s� <br /> �, Court ;�] <br /> Motel ❑Other_ /1?P '--�� <br /> Number of living units:--/ <br /> ------ Number of bedrooms 77 <br /> -- . Garbage Grinder��'_.___ Lot SizecaC�p <br /> Ater Supply: Public System and name --------------- ------ ------------------ <br /> Character of soll to a depth of 3 feet: Sand'.. Clw - Private <br /> Silt❑ ay ❑ Peat❑ Sandy Loam Clay Loam .❑ <br /> -- Hardpan ❑ - Adobe'[] Fill Material ------------ If yes, type ---------- ------------ <br /> (Plot pian, showing size of lot, locati n of sy fem int elation to wells, buildings, etc. must be placed on reverse si <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is,available within 200 feet,) de) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK"'( � J� X ,1 r' <br /> Size 'k --- <br /> / �p�. -------- ----- - Liquid Depth ------ -------•----------- <br /> Ca acit <br /> p Y<. ne TYPeTxf __? - Material ��No. Compartments aZ-_ (f <br /> Distance to nearest: Well 1 <br /> ---------------------Foundation lle9-------------- Prop, tine _ <br /> LEACHING LINE � <br /> [�No. of-Lines r _ --------------------- <br /> teF; o each=ii�e -------- Total Length"/4!- <br /> 'D' Box - - 14 ------ <br /> -- Type Filter Material _ -QC <br /> �f __---Depth Filter Material ------------------ <br /> Distance <br /> to nearest: Well -_�"�D____--___-_ Foundation Ar__�-_ _ __ <br /> _ _ Pro <br /> SEEPAGE PIT s. -_._� �' Property tine �_- \` ' <br /> l Depth ------- Diameter ---------------- Number ------- •- <br /> - -------------- Rock filled} Yes � 4Jo .� <br /> Water Table Depth ----------------------- _Z_ <br /> _.Rock Size <br /> Distance to nearest: Well <br /> -----.Foundation --- Prop. time <br /> REPAIR/ADDITION(Prev. Sanitation Permity ----•- .-- -- <br /> . Date # i <br /> ------ ------ <br /> ptic Tank (Specify Requirements)_ ---) _-_ -__t c3 .� <br /> ! - --- ------------------- <br /> Disposal Field (Specify Requirements) ___________•___• ___ <br /> ------ <br /> - <br /> ------------------------ <br /> --------- -------------------- <br /> --------------------------------------------------------- <br /> -------------- _ <br /> 1. <br /> _-. -- - -------------------------------- ----•_ --------------------------------------------------------------- _'_!-.-�--C--__--_--__---_-_-_- <br /> :, — --------------------- <br /> ­(Draw-existing-and required-addition on reverse-side) - v4T _ _ <br /> I hereby certify.that I have prepared this application and that the work will be done in accordance ;wijh San J"quin <br /> County Ordinances, State Laws; and Rules and Regulations of the San Joaquin Local Health District. He,owner or licen- <br /> sed agents signature certifies the following: otte <br /> "i certify that in the performance_of_the work for which this permit is issued, i shall not employ E <br /> as to become subject to Workman's Compensation—_ - of California. � -. �.T _{R Y an y person n such manner ` <br /> Signed -_- ' f]`.]1 <br /> --- ----------------- <br /> --- --- - --- ----- --------------------------------------- Owner •--� <br /> ----------------- Title <br /> (If other than owner) .aC. -- <br /> -------------- <br /> FOR .DEPARTMENT USE ONLY <br /> BUI LDING-PERMIT--_ISSU€D---_:__-_� <br /> PPLICATION ACCEPTED BY -------------------- <br /> - -- ' <br /> -----. DATE 1 f f <br /> ADDITIONAL COMMENTS - h --- -`- <br /> ---- <br /> ----- <br /> ---- ------- <br /> ---------------------------------------- <br /> - ----- -- ------- ------------------------.-------------------------------------------------- ._ <br /> Final Inspec#+cr b} .� ---_ <br /> - -- ----- - <br /> w <br /> - -- ----- - ------ ----- ------ ----• ---•--.-Date ----- -- -- --------.-•- -- -; - <br /> SAN JOAQUIiv LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M, <br />