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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------------------------- ---- -- <br /> (Complete in Triplicate) Permit No. . __t - <br /> ---------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued l'_:.-.l`7: ? <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 riiade in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .� c,; 11!l�___-)T-:--__j- _______��...�023--- -----------------Rev ENSUS TRACT -------- __ _ <br /> Owner's Name --- -- X I.'- � 1%.f/Z--------------------------------------- ----. . Zt�� � �� ��------. <br /> �� ��)���� .--- -f--- � --- Phone <br /> ---- - - --- ---- <br /> Address ------ -��- 1-91---,, -- � - � RP --. City � / ------------------------------------------ <br /> ----- <br /> ---- -- ---•------ <br /> Contractor's'Name _ :. - �j J_/C - -- - - ---- - ---1_----_ --- ---------- # � -l�.Y____ Phone . '_ _.:�-f <br /> i y f <br /> A <br /> Installation will serve: Resideh& [;Apartment H use❑ Commercial ❑Trailer Court i❑ <br /> Motel []Other --------------------------------------------- <br /> t � FGarbage Grinder _ __'_____ Lot Size . <br /> Number of living units:.--_[._____- Number of bedrooms . ¢_____ g l4C_R ____._._.__ <br /> Water Supply: P System and name ----------------------=----•----------------------------I---------------------------------------------•-------PrivateRJ <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay 5"' Peat':❑``yy__Sandy_Loa m ❑ Clay Loam F-1Hardpan❑ Adobe ❑ Fill Material _11i --- If yes,type ----------- ------ -_ __(Plot plan, showing size of lot, location of system i rblation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No se tic tank.or seepae- it- er i �{ public sewer is available with?in 200 feet <br /> N,a y. dry,` , . <br /> PACKAGE TREATMCNT [ ]. SEPTIC TANK [ ] Size--,� _.___ _.____1,-z...;r �_ ».i .--- Liquid Depth -------------- -------- J <br /> Capacity -------------------- Type -------------------- Material-__ Compartments _ .............. <br /> Q <br /> Distance to nearest: Well ,_�_ .____________________Foundation -_--_-. -__-_-___-. P[ap. Line ......._.............. <br /> yl J V A ;f 1 '�„' / <br /> LEACHING LINE ['] No. of Lines ;__ .a�a ._,_ ,..__�;Lgngt each line___ ______-_ -_ __._---_ Total Length ________________________ <br /> 'D' Box __.--------- Type Filter Material -------------- Depth Filter Mate?,al -------------------- -- __________________Distance to nearest: Well ------------------------ Foundation ------------------er---- Prgperty Line ___..__.___..._____ <br /> SEEPAGE PIT [ ) Depth ------ Diameter ____ __________ Nur fiber_----------------------------- Rock Filled Yes '0,) No 0 <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> '-c <br /> Distance to nearest: Well .-_______________ _____________________Foundation -------------------- Prop. Line ------------......... <br /> REPAIR/ADDIT16N(Prev. Sanitation Permit# -------------------------------------------- Date ................................... ) <br /> Septic TankXK <br /> a if Re re encs i� 1 e c.zf>jf/ C r [� 'r <br /> Disposal .Fie (Specify Requirements)1.L::��s-- --------- i =, ��7r �' Vit__ "'.- -- - ---- --- C—J— . .�N44 . <br /> -fQ P4R4 -------*-----` t �'?d� ` -AN! <br /> ------------------ ------------------------------------------------------------------------------------------I--------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I 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 liven- <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 such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed. - OwrLe! <br /> BY -- C1.. - - L_c J itle . ---- ------- -------------------------------- <br /> (If other than owner <br /> FOR DEPARTMENT USE ONLY <br /> h: <br /> APPLICATION ACCEPTED .BY ------l__!-_F1�-U______________________ ---------------------------------------------.­ DATE ....._`7_--.26--6 _ <br /> BUILDINGPERMIT ISSUED --------------------------------------------------------------------------- ---------------=--------------DATE -------- ----------------------------- <br /> 'ADDITIONAL <br /> ------------------------ - <br /> ADDITIONALCOMMENTS ---------------------------------------------------------------------------------- -------------------------------- ---------- ------------ <br /> -------------------------------- <br /> ------------------- -- ------ ------ --------------------------------------------------------------------------------------------------- --------- <br /> ------------------------------------ --- ------------- ---- - -- ----- --- - -- --------- <br /> -------------------------------------------------------------- - -- <br /> FinalIns ------•-----------------------------------•---Date --------------------__ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />