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FOR OFFICE USE: " OPLICATION ..FOP, SANITATION PERMIT <br /> i = <br /> ----------- ----------- ------ Permit Na. -9 <br /> 344 <br /> (Complete in Triplicate) <br /> --------- ----------------------------- ----------------- <br /> _______________________________._____._._____-_- This Permit Expires 1 Year From Date Issued <br /> Date Issued 1��C�_` <br /> Application is hereby made to the S'n Joaquin,{oval 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 /> F JOB ADDRESS7E CATION.`°,."�'�/'' ----?-;51-!,---�if-6we/`/-C.4Al = ---------- <br /> [ '..'. CENSUS'TRACT -------------------------- <br /> Owner's Name ------------------i PoLPW------13 _&P.-------------------------------------->-------------------Phone--------------------••----- <br /> Address ------`--- -------- ��t e_at <br /> ��fJG} 'A _ �. City _r1c�-�_ _r> 5 -------------------- ------- <br /> Contractor's Name ....A-4-f----Fa44&- <br /> License # _� ? Phone ---------------------------- <br /> Installation will serve: Residenc%oApartment House❑ Commercial ]TrailerfCourt ;❑ <br /> Motel Other _ <br /> Number of living units:____-1_-. Number of bedrooms --- .-----Garbage Grinder --------- __ Lot Size -__________- <br /> Water Supply: Public System and name ----------------------•----•---•---,------------------------------- --------------------------------- Private ] <br /> t Character of soil to a depth of 3 feet: SandE] Sift❑ Clay ❑ .Peat❑ Sandy Loam Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If'Yes,type --------------------I------- <br /> t (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed 'on reverse side.) <br /> i <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,j <br /> l PACKAGE TREATMENT [ ] SEPTIC TANK [ ] n Size------------------------------------------------ Liquid Depth ----------------_.--,--•-• <br /> Capacity -------------------- Type -------------,------ Material-------- --- ------ No. Compartments ------ ----.._:: J <br /> Distance�to nearest: Well ------------------------------------Foundation ---------------------- Prop. Eine _..................... <br /> LEACHING LINE [ ] 'No., of Lines ------------------------ Length of each line-----_--------------- ------ Total Length -----------_----------_--•- <br /> r <br /> D' Box --------- Type Filter MaterialDepthFilter Material --------------- --------------------•-_-----Q <br /> iDistance to nearest: Well __ _____________x______ Foundation ------------------------ Property Line. --------.-.______---__ <br /> s. SEEPAGE PIT; [ ] Depth __________________ Diameter ---------- -_ Number ---------------------------- Rock Filled #.Yes ❑ No CIT <br /> # Water Table Depth ------------------------------------------------Rock Size __ <br /> Distance to nearestWeil I <br /> : ------------------ <br /> { ------------------•---Foundation ----------------- - Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------.-----.------------1 <br /> Septic Tank (Specify Requirements) _______________ <br /> Disposal Ilield (Specify Requirements) ----------- G <br /> - -------------------------------------------------------- Q ' <br /> ---------------------------------------------------------------- <br /> -------------------- -------------------- -------------- ------- ------------ <br /> ---------------- -- - -------------------------------------------------------------------------------------- -------------- <br /> (Draw existing and required:addition on reverse side) i <br /> I hereby certify that I have prepared this application and than the.ywork will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, andwRufes and Regulations of=the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the <br /> "I certify that in the performance of the work+for wh1-iVihi's:perrriit'is issued, I shall not employ any person in such manner <br /> as to become subject to orlynan's Compensation'laws ofCaliforniaa'p <br /> Signed ?1• ----------------------------------- caner rt <br /> a <br /> BY _ _.._..- .Title ------------------ . �.. `�--------------------- <br /> (if ' F 1 <br /> 4 <br /> other than owner) ; . . - 1'' <br /> FOR DEPARTMENT USE ONLY -. <br /> f j :�.� <br /> APPLICYITI'ON ACCEP:-TED"BY "`y = _ "�_�'------------------ _::-------------- --------. DATE J �� <br /> BUILDING PERMIT ISSUED --- - -. '""•"" ----� __.....-D"AT ------------- --------------- <br /> ADDITI.ONAI.=COMMENTS -"•-------` _--- ._'"e', =-= -, '-- P - <br /> --------------�--------'--—--------- --------------------------------------- --------------------------- <br /> ------------- ----------•-=�� t----------------------.---------------------------------- --------- - -------------------------------------- ------------------------ <br /> = --------- Y - -,,- <br /> Final Inspection by - --------- ------------ Date : : 5- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r C <br /> r <br /> E. H, 9 ,�,1-'68 Rev. 5M <br />