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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit.NO. ... <br /> ��................................ (Complete In Triplicate) <br /> ....... ii.._--- <br /> . --•--...__.........---•- p hate Issued ................. <br /> R ., <br /> - _ .._...... This permit Et<k Ires 1 Year From Date Issued � F <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein , <br /> M tion is made In compliance with Count Y Ordinance No. 549 and existing Rules ancl-Regulotions, ! <br /> described. This app ')!ca <br /> !1. O iS �' `-'j E TRACT ... , <br /> � NSUS R -- - <br /> JOB ADDRE55/LOCATI "" <br /> _.. h <br /> Owner's Name .,P.�..�.._.._. .�"A 1. .. _.�--•...............••-......._.......... <br /> ...................P one ............................. .. <br /> Address 1 . _...__..... City <br /> ..___.--•---._... _... <br /> •--•... Ce _....__..... <br /> Contractor's Name�i .!!✓k.c.,.*.a���'�--��� <br /> _ �--, .,.....License # .112.- ...`7 Z7Phone <br />° lnstailatilon will serve: Residence$(Apartment House C3Commercial❑Troller Court <br />► it Motel ❑Other ---- ------------------ •--------• ----- A.- <br /> r� Garbage Grinder _ Lot Size ------------••-4��•�-----•---- <br /> Number'of living units:_.___!_---- Number of bedrooms --_ <br /> I �, Private <br /> a _y _�_.... _ - <br /> Water S lipply: Public System and name ------------------ ---•... ... - <br /> Peat Sand Loam C1 Clay Loam 0 <br /> i Character of soil to a depth of 3 feet: Sand Silt C�a� ❑�•'-# ❑ y <br /> I Hardpan ❑ Adobe:0 Fili Mat�rlal ------------ If Yes,type ............... ....:....... <br /> t buildings, etc. must be placed on reverse slde.) <br /> {Plot plaln, showing size 'of''lot, location of system in relation to wells, !)able within 200 feet,) <br /> �I. �t ermined I# public sewer is ave <br /> NEW INSTALLATION: (No septic tank or seepage.p p p <br /> Size.-- --'-- --•...................-•---- ------ --- Llquid Depth .._..-----•-•----- <br /> ....... <br /> ! PACKAGE TREATMENT [ SEPTIC TANK I I I �►- <br /> ,,, <br /> -__- - o. Compartments <br /> Capacity Type. � Moterial <br /> Distance to nearest: Well `_____ _ ... �_ _ !: .....Foundation <br /> -------- Prop. Line <br /> r I ©f..-"--••- Total Length �i .` <br /> Len th` of each line.___ <br /> LEACHING LINE [ ] No. of Lines r <br /> s g <br /> —11 <br /> ' Depth Filter Material _. <br /> ' 'D' Box ... ..... ... .......................... <br /> •�•---- Type Filter Material.I�� - P / V, <br /> [ �: __.._. Property Line // � <br /> . . p ty --6.-..................No <br /> Distance to nearest:,WeE.I °..� .�-..-_� Foundation ..--.---•---- • - <br /> ii <br /> Depth <br /> Diameter <br /> ter _._. ---- --- Number ....... ........."...... . Rock Filled Yes ❑ ❑ <br /> SEEPAGE PIT [ ) ' <br /> Water Table Depth .. --------------------•••--3-=--••--•----Rock Size ...............•---- - <br /> Distance to nearest: Well _ .':.--------t -----i- --• <br /> Foundation .... Prop. Line _--------------- <br /> REPAIR/AADITION(Prev. Sanitation Permit# ( � Date -....----•--• <br /> 3 Septic Tank (Specify Requirements) --- .g.......; ...................................... <br /> II ; ' ---------- ---------- -- <br /> ( Disposal Field (Specify Requirements) ----...- <br /> }r _ <br /> -------- -------- -••----•-- ------------------------------------ ••••.. i..- . <br /> it ---------••------------•---- <br /> (Draw existing and required addition 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 licarl <br /> sed agents signature certifies the following: arson in such manner <br /> "1 certify that in the performance of the work for which this permit is .issued, I shall not employ any p <br /> as to t el come subject to Workman's Compensation laws of California." <br /> �I Owner VVV�w <br /> Signed`-------------------------------------------.---------------•--------- ---- ----- <br /> __ Title - -- <br /> BY �� .--- <br /> i (If other than owner) <br /> l FOR DEPARTMENT USE ONLY <br /> AP.PLICATiON ACCEPTED BY ---- -•---- --•--------------------------- <br /> DAT! <br /> ` -•- - - •------ - -------- -- -_-- •---------••--...-----�...- -DATE - -- --- •-------- -------------------•--- <br /> BUILDING PERMIT ISSUED -------------- -- r <br /> s ADDITJONAL COMMENTS ... _:. -• - <br /> - ...._.._....---•--------------•------ ----- --------------------------------------- -------..-------- .._._...-- ........... <br /> ---------- ---------------- ; <br /> �I`.. e..__.. <br /> ... . <br /> q - ----� .. 2�T <br /> .._..-------•--•---- ...----....---�---------- ---- -- - Date ----......-...-•--�- <br /> Final Ins ectibn b <br /> Eli 1S24 1-68 . 13etr. At x` SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />