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F FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> � Permit No: --- --- -------_. <br /> ----------------- ---------------"------- (Complete in Triplicate) <br /> -------------------------- p Date issued <br /> ------------------------------------------ <br /> Date <br /> ------- ------------------------------ <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. This appliis made in compliance withConty Ordin qce No. 549 and existing Rules and Regulations- <br /> cation <br /> H x <br /> I ( � �i[ %� �p6>_--- .-CENSUS TRACT ----- ` <br /> JOB ADDRESS/LOCATION /0� 46-(- " 349 <br /> Phone •l <br /> Owner's Nam Q�1 '-- <br /> . <br /> Address - o ✓Ft �� � it! �tY .. <br /> --- <br /> - �rY <br /> 1 i __:License $.1?.,�..-�_ Phone <br /> Contractor's Name _ - �1� ----------- i <br /> ------=--------------- ------ <br /> � I <br /> Installation will serve: Residence ❑Apartment Hawse ] Com�nJrcial ;❑Trailer Court ',❑ ,il <br /> { 1 <br /> Motel ❑Other _ � ;t mwi V�`-'j--`=V <br /> t �— ,� iA C'e4.�--------- <br /> Garbage G�rmder _.--__.:_ _ Lot Size _. ___. _______ ___ _ ___ <br /> Number of living units:---- Number of bedrooms .- �+�--:. - <br /> k Private DPI <br /> Water Supply: Public System and name ------------- -- i- - I ------------ <br /> t r Wi, ' y ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ `6lay ❑ Pe t;❑ Sandy,t�oam Cla Loam <br /> j I '. <br /> Hardpan E] Adobe ❑- Fill Materi4I _"----_---- 1f yes',type ---------------------------- <br /> i k I f I <br /> k €� <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etch must be placed on reverse side.} <br /> p p �,e p• perm <br /> tied ifs u, sewer sewer is avdila��e within 200 feet,) s� O <br /> ,/ �— <br /> NEW INSTALLATION: (No septic tank or see a iti k �,( <br /> PACKAGE TREATMENT [ ] <br /> SEPTIC TANK [� 5�ie - '`_.--7- X-�` Liquid Depth __ -------- <br /> E I "-- __ Tip Material � o. Compartments .---- ---•- -- <br /> ( 3� Capacity <br /> ` 1 t `t 6 I . , l E� x" Prop. Lln <br /> Distance to nearest: We -_ '_Foundation[_ P• <br /> 1 [ or <br /> --------- <br /> LEACHING LINE [� No. of Lines _13----------------- Length tof each :line.--�Q-_----- -- ] Total Length C- -- <br /> 'D' Box Vf l <7 I <br /> _ <br /> _ Type Filter Material - ------- -- ----Depth Filter Material <br /> � � --�-----Q-----f------- <br /> ; I ----------- <br /> Distance to nearest: We : l__--.- Foundction ---- Property LinN <br /> SEEPAGE PIT [ ] Depth Diameter _____�_.E_-_____ Numer '-;- ---- Rock Filled Yes ❑ No ❑ <br /> ------ <br /> ( Water Table Depth ------- V -------• -L- -Rock Size =!------------------------- <br /> ( �' Foundations ------------ ------- Prop. Line ----=---------------- <br /> 1" Distance to nearest: Well ---------------1 " _-_--_--- <br /> %. � �i <br /> REPAIR/ADDITION(Prev. Sanitation Perm€t# _--_ ----------------- FWr F <br /> ;--------------------- ---------------------------_-.--------------------------- <br /> Septic Tank (Specify Requirements) ------------------------------------ i # a <br /> .------- --------------------------- <br /> Disposal Field (Specify Requirements) -------- ------- = ' =" <br /> ------------ <br /> -- - - --------------------------------- ------------------------- <br /> 4 +----------------__.r��.:c--_-_- ----------------- <br /> ---------------------- <br /> _--.-----_-_-- ________.___ <br /> f } t { 4 <br /> --- --------------- =----- Ora-- existing G <br /> 1 (praw existin and re wired addition on reverse side) <br /> I thereby certify that I have prepared this application anldwth;ot\fhe wor will be done in accordance with San Joaquin <br /> 'County Ordinances, State Laws, and files and Regylati ons of the {an.P aquin Local Health District. Horne owner or licen- <br /> sed agents signature certifies the following: f _ _ <br /> k `dl certify that in the performance of ffte work which this perrrtitii issued, I shall not employ any person in such manner <br /> {s to become subject to Workman's Co'npensation laws of California.'{ ,, <br /> ' k"' C 1 1 <br /> Si ned ( r . Owner <br /> 9 --- ----- -- -- <br /> I Y <br /> BY ¢ = s a Title - /1= <br /> { <br /> (If other than owner) <br /> 1 FOR DEPARTMENT jUSE ONLY <br /> APPLICATION ACCEPTED BY --------- -------- s <br /> - -I DATE �/` <br /> TE <br /> tBU(LDING PERMIT ISSUED ------------------------ <br /> --------------------------------------------------- DA <br /> 'ADDITIONAL COMMENTS ----------------------------------------------------------" �-----------------V-_-_-_-_-____-_-_-_-_-_-_-_-_________.__________-------------------- --------------------- <br /> t _ __ _ <br /> • ___________________________________________ __________________"__..__________-- ---- ------------------- <br /> --_-_-_----_ .-__----_--. <br /> • ♦+� _ ------------- <br /> 1 e------------------ ----�`� -------- I ' ' <br /> } " ----------------------------------- r { Date _-��--�U----'-- � ------ <br /> ,Final inspection by: --------------- --- �"�------ " <br /> SAN 4JOAQ'iN =I:OCAL HEALTH DISTRICT. <br /> rC <br /> F y 4 1_'68 Rev. 5M <br />