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f <br /> r FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> f.............. ...................................... .� _ er p Permit No. ... 2.- ,�.. <br /> I ;Com fete in Triplicate) <br /> Z Date Issued .X-:;�x..7.3 <br /> ......................................................... This Permit Expires 1 Year From Dale issued <br /> i <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/LOCAT16N —.23-1Z... xaadrid e._,..._..•k..:.:-_-.._`:......... .................... .......CENSUS TRACT ..............:...... <br /> :.... <br /> Owner's Name ...Hrz' ..EQx ...c:...........:.. ..Phone .... �(r��3 ......... <br /> 1 18 Porter .... r...,, . _, Stkn' <br /> y <br /> Address ..----•--•-----•--•------•-----...----•-------------±._---....:--------------•-=------------------•--�Cit --------••-------•---•-----...................................••------•--.... <br /> 4.f. tis �f h .rY �w.• t� �.i+iMro r 'w yr r.+� . <br /> Contractor's Name .......B1akarr 's-.Sep.tk........................License # ------26-8951.. Phone ...?1: 3I:.7D. $.k... <br /> Installation will serve: Residence 10 Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other ....................' ------------ — -^ <br /> Number of living units:.-1....... Number of bedrooms ---4......Garbage'Grinder ............ .Lot Size l:__.__1QD_'X18.0.!.._.;- _ ._... <br /> Water Supply: Public System and name ................Cjty........................................................................ ........Private ❑ <br /> I Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ 'Peat E' Sandy Loam❑�` Clay Loam [� <br /> Hardpan Q 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 publk',sewer is available within 200#feet <br /> ,) <br /> PACKAGE TREATMENT [ ],<` SEPTIC TANK tW Size.......fi e X7-!-XIal.................*'Liquid Depth....... <br /> 5-6.......... <br /> ---- <br /> el <br /> Capacity ........�D.Q,..--- Type ....s. . Material........co .t....: Na. Compartments .....2...............1 <br /> Distance to nearest: Well ...-=Arm rmn .......Foundation JA------------- Prop. Line ... !........... <br /> LEACHING LINE µ No. of Lines ...._ _ g g0 Total Length ...1§0 <br /> F ] �.---•--•---..._.. Len th of each line.....:..........`�'..._. . ..._..............� <br /> { 'D' Box ...........: Type Filter-Material ..:......2?'_ Deptf - Filter .Material ...._.......� 9. 1......................... <br /> Distance to nearest: Well ........ •:-.`.. Foundation ... __2Q.'............ Property Line ._..._rye_.............. 0 <br /> 5 Depth ........ldf . X.. <br /> .. ... . =..-. .. Number Q� <br /> Water Table Depth _.. ------ ............. Rock Size 2'.'.................... Q! <br /> 0' <br /> i Distance to nearest: Well ------- ..................Foundation ......0Q........ Prop. Line 5►.......__.._ <br /> REPAIR/ADDITION(Prev. Sanitation Permit�# .... ................... �...--......__ Date .............................. <br /> I <br /> _.....Se tic Tank IS ecify Requirements) ------------•--------------------....... <br /> .............................- ...._...._.. <br /> -------------------------------------- <br /> ------------------ <br /> ,. Disposal Field {Specify- .Requirements) ---18�!..�,e�.ch--Zr ��-`--&-•��---�-��2p�•-ZF�•�8�•X�•0-'-=----•---••---- <br /> -----------•--•----......................_1................._ .................................... <br /> •.............................. ...•----....... <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 /> licounty Ordinainces, 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, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed . r.._.. ----------- <br /> • ------ <br /> . Owner <br /> By ..._. ....---• 1 ------ Title ......---conractor <br /> (If other than owner) <br /> _ OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 13Y .— <br /> V• - ---- -��- -----•- ---.. �.,� J.-- •-r��•. - DATE .. _. <br /> BUILDING PERMIT ISSUED . ... f ,' ... �-••-------• --- I- Z;;;7............. <br /> . ..... -------------------...........................:..............DATE <br /> ADDITIONALCOMMENTS . ... . ..... ......... ... .J--------------- ----------••--- ----..............-----.....----..._..._..._......._......_.....:---•------•--- <br /> .................... •--•... <br /> -•--- -------------•------ <br /> ..................................... :.. ......... ... . •---••--: .. ..................--•-•--•---........_..-----•-••.....:...._............--•••-•-•---...._....---.....__......._..-- ........ <br /> ............................ .... --_.. <br /> ....... <br /> Final Inspection by .................Date .. . ...... <br /> # r SAN JOAQUIN LOCAL HEALTH DISTRICTN. <br /> F w 13 24 I.-AA 1?o. ;AA 7172 3-M <br />