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19. <br /> OFF( E USE: �_ APPLICATION FOR SANITATION PERMIT <br /> ..... ............,............ ..�.1.... -.._..... Permit <br /> (Complete In Triplicate) <br /> r <br /> :� ... . <br /> ..................... .. ... ... .................. This Permit Expires 1 Year From Doli issued <br /> Date Issued1 ,7S y <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal) the work herein <br /> described. This application is made in complianc <br /> e w' County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _ o34G0 /Y ...............................� TRACT .......................... <br /> Owner's Name .................. .,r ) Q...,........,............. ..Phonoz.%?./.......... <br /> Address ---_._. ----------_....... lsz..fl _.. ..... F-Wil...... Ci .......................•..... ....... ..•............. <br /> Contractor's Name '_License tM ........................ Phone <br /> _. . �....f ............. <br /> Installation will serve: Residence 0 Apartment House Commercial❑Troller Court 0 <br /> Motel❑Other............................................ <br /> Number of living units•_.---1 Number of bedr ........Garbage Grinder ............ tot Size ......./... .........•...... <br /> Water Supply: Public System and name •..................................•....•.............._............................•....•.................Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam O Clay Loam <br /> Hardpan Q Adobe Pt 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.)W <br /> NEW INSTALLATION: (No septic tank or see ge pit permitted If public sewer is available within 200 feet,) <br /> �- <br /> PACKAGE TREATMENT ( ] SEPTIC TANK D /�Size....a .`.1�. ........................ Liquid Depth .......................... 0 <br /> Capacity _�. ....... Type I'�s.-44..• Material.6 .__ No. Compartments ...-21............. 0 <br /> loo, of <br /> Distance to nearest: Well .......................Foundation ......f_.............. Prop. Line .... �..�......... <br /> LEACHING LINE No. of Lines --,Z................. Length of each hne-....QR ... __ .'. <br /> g .......__ Total Length ��..... .......... . <br /> 'D' Bax ....../... Type Filter Materiah, . ...Depth Filter Materia{ <br /> .........../�.rr................................ <br /> Distance to nearest: Well�?`�7b ......... Foundation _.-... ,4.. ....... Property Line .... ..... <br /> SEEPAGE PIT Depth ._n.Z..1..... Diameter Number .....Z.... ............ Rock Filled Yes$j No op <br /> Water Table Depth _......Y--C...t......................Rock Size .�1.2!� :�V.+... 9 <br /> Distance to nearest. Well J.Q. . .'..Foundation ...../_.194.: Prop. Line ....../...Q. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. <br /> Septic Tank (Specify Requirements) ..._ ........••-•••••••••••....-••-.._......_....................................._................. <br /> DisposalField (Specify Requirements) -----------------•------........--•-------.....---•-•--•---•--.....-•--•---....------•-----..........._........_..........._......... .. <br /> •----------------- -------------•----------------- ........................................ ----•-•----..•.........--........----•-------............----•-•--.................._......................... <br /> --------•-------------------- ........................................................................... •--............................................................................................ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that i have prepares) 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 licen- <br /> sed agents signature certifies the following: <br /> e "1 certify that in the performance of the work for which this permit is issued, I shalt not employ any person In such manner <br /> as to beco sublet) orkma 's Com nsatlon I of California." <br /> Signed ... _4 <br /> ----.- - - ...... Qwae� <br /> -- -- . <br /> By ---- ------------------------- .. ... ......... Jitle ---- - <br /> (If other than owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY Y <br /> -----. DATE .......... <br /> BUILDING PERMIT ISSUED ------ ----------- ------- - -- ...... ....._..DATE -...-........__._...---- <br /> ADDiTIONALCOMMENTS ........................................................................................ .................. ................................ <br /> -------- ------_..---------- ----...._-----------------------_......_... .................... ... ....... ------•-- .......... ..............---•--......................... <br /> ----• <br /> -----­---------_--------------­11-------- 5 :------_-------- ...... -------- --------- <br /> Final Inspection by: __..f. --"�- .. ._ -•0r---- ------••-- ------•----.... .._.........-_......_-Date �2 ���.. ........... <br /> 13 21i 1-68 Itev. r M SAN JOAQUIN LOCAL HEALTH DISTRICT $/7�, 3M <br />