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a <br /> FOR OFFICE USE: <br /> 'APPLICATION FOR SANITATION PERMIT - <br /> (Catnpl!ete In Triplicate) A. Permit N <br /> r Date issued ...... d...en <br /> :........ ................ .. .............' This Permit Expires 1 Year From Date Issued <br /> � <br /> Application is hereby made to the San Joaquin Local Health District for a permit,, t©' 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/LOCATiO ...... 1 '4:. ..... ... ...--6j--. '`5 . ._..... ...........CENSUS TRACT ............. . .:-.. <br /> Owner's Name _.._._.... � .... ... .. :. . ..,._,€.:....'... ......Phone _'. �Y-Y. <br /> Address ._..... - G SD . .:. City . f '......�............. -..-.-.-- <br /> Contractor's Nam ........` �..._.._...- - ......._ �.. .Phone _k.0 Gd:.. 7.6 7 <br /> Installation will serve: Residence d Apartment House 0 Commercial[Trailer Court 0 <br /> { Motel❑Other............: ........ <br /> Number of living units _..,_ Number of .bedrooms .3-. Gorbaget-G�inder :... ,..,lot Size `3 <br /> Water Supply: Public System and name -._...._ .�4 %S0` 'L .......Private .. . <br /> ......._. ......... Q. 11 <br /> Chara`cter of..soil to a depth-6f 3 feet: Sand 0 Silt 0 Clay ❑ Peat 0 Sandy Loom(3 'Clay loam <br /> Hardpan 0Adobe fl Fill Material ............If yes,type................. <br /> V` <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings;`®tc. must be iplaced on reverse side.jl <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 f et,)) \\ <br /> PACKAGE TREATMENT ( SEPTIC TANK I ] Size............................................ Liquid Depth.. ., ........ _ <br /> Capacity -- - ------------_ Type Material . :�........... No Compartments <br /> �a'.� <br /> %4 <br /> Distance.to nearest: Well ...................... ..... �zFoundation .. .E.......... . Prop. Line ......... <br /> LEACHING LINE [ ] No. of Lines --• Length of each line............. ..,:. _. Total Length` ..... .. <br /> Material ....................Depth .Filter Material f ....��":..1- <br /> Distance to nearest: Welt .. Foundation Property Line <br /> , <br /> 1 ................. .. <br /> 1 # <br /> SEEPAGE PIT [ J Depth1 !-------. Diameter ..... . <br /> Number ......... Rock Filled. Yes 0 No C], <br /> Water Table Depth .....Rock Size ' <br /> I <br /> Trop, Line . <br /> Distance to nearest: Well _........ ....: .................Foundation ._... .: ....... .................... <br /> REPAIR/ADDITION( r v. SanitatiantPerrztit. ` ..... .........:.:.. Dae `� Wi l•-•:......_..... <br /> .} <br /> Septic Tank {Specify Requirements) I <br /> Disposal Field (Specify equirementsl • ......C!.:..ate.__-_.-•- .... &—opx.Q..-- --------.............................. <br /> r , <br /> -:-_-_.'--... ........................... <br /> ----- ................l 1 <br /> ti t <br /> _ . .............................................................s ................ <br /> ' (Draw existing-and•required.odd.itionvn,reverset 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 Sart Joaquin Local Health;Qlstrict. Horne owner or liken- <br /> sed agents signature certifies the followin#g: '14`"t,::, ;; <br /> "I certify that in the performance of thelwork for wh`ith this permit is issued, I shall not employ ay person in such manner <br /> as to become subject to Workman's Com'pensationylaws of California." <br /> Signed . ----.... Owner w . <br /> By - .. ...---- Title <br /> . .. ........ .....• $ __... ... ............... ...... ............. <br /> .. <br /> If her t a owner) <br /> r , <br /> a OR"DEPARTMENT-DISE-ONLY--ONLY-­ <br /> ,APPLICATION <br /> APPLICATION ACCEPTED B ...-e.c... - .. _ ,rr'. 7 <br /> ----- ----- DATE <br /> _BUILDING PERMIT ISSUED ...--••---•.....................: .. t , DATE ._..-.. <br /> • ....................... -----... ............... <br /> ADDITIONAL COMMENTS-__....... ..... ............................................... <br /> .. <br /> --- •M <br /> ..................................... <br /> . •-• ... .... •- ...... . . <br /> FinalInspection by . •--............ ........• --••-•-•--................___-..................--_,.. .._ . .._���..-.._. . <br /> Date .....` <br /> EH 13 .2h 1-68 1te Vit. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />