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FOR OFFICE USE: <br /> APPLICATION, FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. <br /> --------------4i -0---------------------- <br /> - - - <br /> ---------------------------- <br /> - <br /> Date Issued . <br /> ---------------­---- ------------------ This Permit Expires I Year From Dot*Jssued <br /> _-______ _„__________ <br /> 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 o, 549 and existing Rules and Regulations: <br /> kA . .. .......... .............. ............ <br /> ---4 <br /> JOB ADDRESS/LOCATION ----- -----jw- <br /> ---- --------------------CENSUS TRACTr <br /> Owner's Name ----------- 4_Zaelv-------.1no-ov -is-------------------r----------- ------Phone ------------------------------------ <br /> Address -------- Z- ----------------------------------------------------------- .......... city ---- .............................. ..................... <br /> Contractor's Name ........ -------- ------__­--------License #10 A ft.. Phone 366 441' 4K 144 <br /> Installation will serve: Residence 0 Apartment House-0 Commercial.oTrailer Court )0 <br /> Motel f-1 Other--------------------------------------------- <br /> Number of living units:-.-/----- Number of bedrooms ..A...-.Garboge Grinder &-. Lot Size ................... <br /> Water Supply: Public System and name ....................................... ------------ .........................................................Private <br /> Character of soil to a depth of 3,ftet: Sand E]; Silto Cloy E] ftot[] Sandy Low 0, -Clay Loam_o <br /> Hardpan E] Adobe V5 Fill Material ------------ If yes,type _---________-------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank,or seepage pit permitted If public sewer is available within 200,feet,) <br /> PACKAGE TREATMENT 'SEPTIC TANK O'- Size J� X X----9. .. ....1- Liquid Depth ....... ---------- C44 <br /> No. CompartmentsCapacity --- Type,j".0r4__;!_ �ateria Co m �Aog—-------- <br /> Distance to nearest: Well ---- .............--------Founclatio' n'l-0116............. Prop. Line ---_---------- <br /> LEACHING LINE No. of Lines ------/........I------ Length of picS4 lin 5_._t -- Total- Length jr-'0'40.40............00401 -------- <br /> - <br /> 'D' Box _,eV.4_ Type Filter ........ <br /> Doi Zle......... ......... .. <br /> pth Filter Material <br /> Distanceto nearest: Well _w77%"r..... ... foundation e-___-_____-__ Property Line -------- <br /> SEEPAGE PIT, Depth ------- Diameter s9....... --- Number __--- ----------- Rock Filled Yes>( No p <br /> - <br /> fr <br /> Water Table Depth --7 .............................Rock Size ..14.....al.............. <br /> 00 0 <br /> Distance to nearest: Well .....,oe _�O_e-------_----------Foundation ..V-40 Prop.p. Line ..A6------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _------------------------ -------------- Date ............ ..................... <br /> Septic Tank (Specify Requirements) -------- -------------- ------- ------ --_-------- -----_----_----------------------------- ------ -------------------t..,:. ....... <br /> Disposal Field (Specify Requitements) ...... .......... -------------_------ -- ----- --------------- ----_------------------_-_----------*---------------- <br /> ------------- .......... ........... ...... ---------------------------------------------........................ <br /> 4, <br /> - <br /> ------------------------------------------- ---------------------- ----------------­----------------------------- --- ----- ----------------------1---------------------------------- <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 Sea- Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the.Son Joaquin Local Health District. Home owns# or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is,issued, I shall not employ any person, In swl_11 manner <br /> as to become sub liato'Workmon's,Conkpon*a”laws of California. <br /> Signedi"--------- ---- ------------ ------------------------ Owner <br /> By ---------I­-------­-------- Title <br /> ---------------- ----------- <br /> (if�oit�h?an owner) ........... ........ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION RCEPTED BY .-Clelp.4111. .......................................................... DATE .------------ --------------------------_- <br /> BUILDINGPERMIT ISSUED....­-------- ----------- .............................. ---------------------­---------------DATE ..............I....................I........ <br /> ADDITIONAL COMMENTS--------- -------------------------------------- ........................................................... <br /> --------------77--------------------- <br /> - <br /> ------------------------------ <br /> --------------------- .. <br /> .. .... ....... <br /> Final Inspection by: ----- ------­-­----------- ........7------------------I-------­----------Date <br /> ------------------------------------------------------------------- <br /> -- -------- ........ <br /> -SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5111( <br />