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FOR OFFICE USE: APPL1CATtOWFU SANITATION PERMIT <br /> _.............-............................._.-...._.... Permit No: ..77..'-/ <br /> (Complete i`+n i Triplicate) <br /> .... <br /> 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 /> sso � <br /> J08 ADDRESS/LOCATION ,....1...... ...._. f�.KE! p w_ r� ....CENSUS TRACT <br /> Owner's Name �_R_ ...E/!.(//�((a• Phone .'.a-�.`l't?�2...... <br /> i- ° , ... . <br /> t Address 'S - . .. .. .. .......................... ............. City ._..�i.L 44c!•►....................... <br /> ..... ............... :... <br /> i <br /> Contractor's Name .... ....::1�:.D ..._..�A .Pj, 'm� . <br /> � ••t�....................................:Ucense # ��'� .-`�---... Phone :..(iZ.6:6...�£.�7..... <br /> Installation will serve: Residence in Apartment House 0 Commercial QTrailer Court 0 <br /> Number to [3, <br /> Other --••-•••••.................................. <br /> Motel <br /> Number of living units:__'..Y..... bedrooms .........Garbage Grinder ............ Lot Size .aT...4�.................. <br /> Water Supply: Public System and name J....... .................................................... ............................Private <br /> soil to a depth of 3 feet: Sond Silt <br /> I [ (� Clay E] Peafi 0 Sandy Loam � Clay Loamin <br /> Character of so <br /> Hardpan [ Adobe '(] Fill Material ............ If yes,type ............................ <br /> (Plot plan showing size<oWq'i; location of s1 sein relation to wells, { <br /> 1 buildings, etc. must be placed on. reverse side.) <br /> NEW INSTALLATION: (No septi tank of seepage pit permitted if public sewer is available within 200 feet,) <br /> RACKAGE TREATMENT [ j_S« EPTIC TAN K f j Size ............................ .............. Liquid Depth .... . ............. <br /> Capacity ...... Material.. No. Compartments <br /> a,� 'P • " Distance to nearest:Well. ........ ... ..... ................Foundation ...................... i ...._... ...... <br /> d <br /> Prop. Line <br /> LEACHING LINE' ( jA No -Lines .._.. I length of each line_.............. .. ........ Total Length ...._....... ._.. <br /> t -• ......_. <br /> 'D"Boz" .... .... Type Filter Material ......:.............Depth Filter Material .............................:........... <br /> .:. <br /> Distance to nearest: Well Foundation .. Property line <br /> ...... <br /> SEEPAGE PIT [ 1 Depth ..................k.. Diameter ...........( .... Number ..._...._........__.._...... Rock Filled Yes ❑ No <br /> I Q <br /> "Awa <br /> ; <br /> Water Table Depth _ Rock Size <br /> Distance to nearest. Well I ::...............................Foundation .................... Prop. Line _. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................. Date <br /> Septic Tank (Specify Requirements) ' ._. - ............. - <br /> , <br /> Disposal Field (Specify Requirements) ..... ... . _.... :... . $ �C...ZS. I <br /> ..._ ... . <br /> -'.._... <br /> +/ ,A <br /> VVV\ .. <br /> V- <br /> t <br /> MA -yaw <br /> .. ....... rg k}-•-q " ._....... . ........ . .: ........ ........: . ..... <br /> _ existin and re uired addition on reverse sidej <br /> I hereby certify that 1 have prepared this application and that the work will be done i c e with San Joaquin ' <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Heal str ct. ome 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, I shall not e o any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .----.......0_9 <br /> - ......... Own <br /> er <br /> By ......_..... Title <br /> (If other than owner) <br /> TMEN7 USE ONLY <br /> APPLICATION ACCEPTED BY ...... .---•••--...I............................ DATE ...._....-7=1 <br /> 1 _ <br /> BUILDING PERMIT ISSUED ... : ✓./.. . ... . ........-••......... ...............................................DATE ...........7....- ..-...:. <br /> ADDITIONAL COMMENTS .._. .. , <br /> �-.:: --- ::: <br /> ............................•-............ ................--•-- ••... --- -- Irt <br /> ...... ....... -••-•.................. <br /> Final Inspection by: ................: ............................... ................................ .... .r`......... .........Date .... .:..................................... <br /> SAN JOAQUIN LOCAL' HEALTH DISTRICT <br /> E. H.13 24 1-'68 Rev. 5M 7 -79 1 u <br />