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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------------------- <br /> (Complete in Triplicate) Permit No. Y"__._.3 <br /> ---------------------------- ------- --- ---------------- <br /> -V_--___.-_-- This Permit Expires 1 Year From Date Issued 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION I~ A" fo'4Iefj <br /> .'- ---4----------"----------------- e------ ------------------------ -----.CENSUS TRACT <br /> 1 <br /> --------------------- <br /> Owner's Name - <br /> a4Aj <br /> ------- -- -------------------Lz ---------------------------------------------------, <br /> ---- <br /> ----------Ph <br /> Phone !, <br /> Address if0? 5,'---- i_ _ Y -<7':Contractor's Name ------------Q_ s-------------------------------------------------------------------License <br /> # ------------------------ Phone ------------------•---_-••-- <br /> Installation will serve: Residence;?Apartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel'D Other -----------------------------------------=< <br /> Number of living units:____I___-_ lr6o ��------Garbage Grinder 07-D --no----- Lot Size _-_ --------------------- __._.._. <br /> Number of bedri�oms _ <br /> Water Supply: Public System and name = -_---------------------------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt C]. Clay W Peat❑ Sandy Loam ❑ Clay loam ❑ <br /> Hardpan ❑ Adobe_❑ 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,) -X-�iA <br /> iV <br /> PACKAGE TREATMENT [ ] SEPTIC TANK:;4 Size---4,_7-<'K-_-__ ---------- 'q p C"s�sTL <br /> Capacity /-�_t___C TYpe =`fit' >` ' <br /> ____.___ Material-�v?_ -No. Compartments ____ ____..___ <br /> Distance to nearest: Well ----- _____ <br /> -----------------Foundation ------- Prop. Line -----�-�-ll--............ �. <br /> LEACHING LINE [ ] No. of Lines --------..?___-____-__ Length of each line------- ---------- Total Length ' <br /> 'D' Box --_`�. Type Filter Materialf-V 404`6 Depth, Material �', __/.............. <br /> Distance to nearest: Well __ ':_____-_-_-_ Foundation /��----------------- Property Line .4 __................ <br /> SEEPAGE PIT [ ] Depth _ --------------- Diameter ---------------- Number -__-__--__ --------------- Rock Filled Yes E�-' No i❑ <br /> Water Table Depth --- %_ _____________------------------Rock Size _. __ __ <br /> --------- - <br /> Distance to nearest: Well _-____-� �'____________________Foundation %0 r_-__--_-_. � <br /> Prop. Line ------------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date --------- __-_.--__-___.-_________) <br /> Septic Tank (Specify Requirements) <br /> DisposalField (Specify Requirements) _----------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------- <br /> ------------------------------------------ ---- - - -------------------------------------------------------------- <br /> (Draw existing acrd required addition on reverse side) <br /> I hereby certify that 1 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 licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compen3ation laws of California." <br /> IV <br /> Signed __ �-�-`--- 7 �- - <br /> / Owner <br /> BY ----------------------------------------------------------------------------------------------------- Title - <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - -- ---A44 c�-------- ---- ------------------ DATES " /--• <br /> BUILDING PERMIT ISSUED ------------------------------------DATE ____-______._ <br /> ---------------------------------------------------------- ---------------- <br /> ITIONAL COMMENTS -------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------- ------ <br /> -- - --------------------- ----------------- <br /> - <br /> q <br /> ------------------------------------------------------- <br /> ----- --- ------- <br /> ---------------------------------------------- ---- ------ - - --- f ' <br /> ------- <br /> Final Inspection by: - <br /> ----- -- ------------------ <br /> ___ --------- - --------------Date -------- <br /> SAN <br /> ---- <br /> SAN JOAQUIN LOCA HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />