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FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT <br /> ....................................... Permit No. ._ 5 _ a5: <br /> (Compl;8 -Tri.plicatel <br /> .................. This Permit Permit Expires1 Year From Data Issued Date Issued <br />................... d... .......... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the worst herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ` s <br /> ,:.... . ..._...._,._..............................l-•_....._.......-- - ._......>.. -----�-.....CEN5US TRACT :...------- <br /> JOB ADDRESS/LOCATION . .... <br /> ....._.._...... , <br /> Owner's Name ..........t '� r.._ z:.1. i......... :....�— �..:.............-....-...-....................................Phone ..................................... <br /> Address _ ............................... City ................._..-------•----- . .._ .......T:..... ......... <br /> //..FF.... <br /> Contractor's Name .....e /JIt/r14� .......'f-__ ®N...... ---------.License # l4�_;.� _. Phone .`-' Z>7 <br /> Installation will serve: Residence ❑ Apartment House] Commercial ❑Trailer Court 0 ; <br /> Motel ❑Other --- <br /> Number <br /> -Number of living units------------- Number of bedrooms ............Garbage Grinder Lot Size ... �_._. :� C 5 + <br /> k* Water Supply: Public System and name .........--- ................---•.. ......................:..............I.......................Private (� <br /> Character of soil to a depth of 3 feet: Sand Si1.t.[] Clay_❑� Peat❑ 5andy Loam ❑ Giay-�❑ , <br /> - :... - ._ <br /> Hardpan ❑ Adobe ❑ Fill Material --_------- If yes,type ............................ <br /> i <br /> IPlot plan, showing size of lot, location o;e/ep relation to wells, buildings, etc. must be placed on reverse side.). <br /> f NEW INSTALLATION: (No septic tank orpermitted if public sewer is available within 240 feet,) <br /> PACKAGE 'TREATMENT E SEPTIC TANKSize..�f...A—C" '__ `.................. Liquid Depth ...-.r .j.......----... <br /> Ca city Z�A !L yp &! CH s <br /> �.................. T e _.._..._....... Material..... �' C'. No. Compartments <br /> istonce to nearest: Well -------------A. --.....--------Foundati :_ ..l....... Prop. Line -._.... .... .._. <br /> C• 36 <br /> LEACHING LINE No. of Lines ------ ---_---_---. Length of each line..._ _..._..._....... Total Length _46��.�.. .. .-- <br /> _ 'D. Box s..__f......tType Filter-Material•....................De th3 Filter Material ........._..••-----------.__..._....-....... <br /> / r <br /> Distance to nearest. Well .... ��..__..___.. Foundation -----lVz.......... Property Line ........................ <br /> SEEPAGE PIT Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No Q <br /> Water Table Depth ............................. ---- ._......Rock Size <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..................................•--------- Date ..............____._-- .........) <br /> N <br /> Septic Tank (Specify Requirements) _-------.---_--•- -------------• .................. --------•---.................-•----------.... ............ _... <br /> DisposalField (Specify Requirements) --------------------------------------- .................................... ....................................... ............. <br /> --...------------------------------------- <br /> ----yam- ---------- __---- - -- -._ -- ... � .� <br /> --------------------------- --------------------------------- -------------------•------•----------- .........................................................I..........I........ <br /> (Draw existing and required addition on reverse side) <br /> I 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 )sten-U1 <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 _A*7,6aN. .-- SO !V .-._ Owner <br /> sy .._.... •. <br /> --- Title .........................................................----------- <br /> .... <br /> ( wner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ....... ..... •................••---......-----............---...........--- ......... DATE ....�ye�:... `. _...... <br /> BUILDING PERMIT ISSUED .:....... - ......-................----------------..................................................... <br /> DATE ........... ---------_--_---­ ---------- <br /> ADDITIONAL COMMENT _ <br /> ------.... ------ .............................•----.................................................. <br /> ...................... <br /> ............................. <br /> ......._.. <br /> ............................... . --- . ----- . ...... ..... . ........ -•----•.. <br /> r <br /> Final lnsp -----_------_- <br /> .... .. -- --....••-•... ........ . Date _ . .`. � � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> c u 1.3 24 1_'ac 0— n" 7/72 3 ,,%t - <br />