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Fog,61'EICE USE: ;APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------------------------- <br /> r Permit No. ___.--3_-� --- <br /> --4•----� (Carrt�lete iir'Trip�l(catel"""""'•—+ <br /> This Permit Expires ] Year From Date Issued Date Issued <br /> Application is hereby, made to the,San Joaquin Local Health-bistrict-for a permit to construct and install the work herein <br /> described. This application is made'in complionce'With`County Ordinance Nd. 549 and existing Rules and Regulations: <br /> r ---------CENSUS TRACT ----- <br /> JOB ADDRESS/LOCATI N . _ � -----/ <br /> Owner's Name -------NRR14---!1W" 'I L50-44----------------------------------------- -- --------------Phone ---------------------•-------------- <br /> Address / ------------------I---)VAP/-------J ------------•--. City: --------------- <br /> ' � 1____.___.._ <br /> Contractor's Name _ x-17---L6', F� -------- - LicefS�se # ----{ ------._ Phone ----------------------------•- <br /> ----------------- - <br /> Installation will serve: ResidenceO<Partment House❑ Commere+.a1j]Trailer Court ;❑ I r' <br /> 9 Motel ❑ Other ------�--------J------------------- r <br /> ats:___---.- Nu inbee of bedrooms - Garbage Grinder/. 49� x -----`}- <br /> � � ! __ Lot Size - _________ <br /> Number of living units-1---- / • <br /> i i <br /> Water Supply: Public'System and name -------------=------------------------------------------------------- •------ Private i <br /> Character-of soil to a-depth of 3 fe t:_ Sand_❑ _S' ❑ _Clay ❑„Peat5 Sandy Loarn ❑,_ Ciay Loam.®� -� <br /> k� <br /> r ,-- ..�_ <br /> �r Hardpan Adobe ❑ Fill Material -- If yes,type _____.__- -___________- - <br /> (Plot plan, showing size of lot, location of.sy.stem--in relation to wells, buildings, etc. must be placed on reverse side.} <br /> I h1gor P Sized �f ublic sewer is available within 200 fee <br /> NEW INSTALLATION: (No septie.fi�arak3or see' e_pit permute <br /> 1 ft � <br /> `� x -------- Liquid Depth --- •----- <br /> Ilk <br /> PACKAGE TREATMENT { ] SEPT, - - -----------•--- -------•--- -- - <br /> Capacit'y _ _ -_OQ- _ Type _UR _ Materia!__ 1 -_ _ No. Compartments _. '------- <br /> r <br /> 000V. l to 1 rrt� t l fi-- Prop. Line __ <br /> �Weare t: Weil�----- �_----'---:_:.�>.�.Foundation '----��--- -------------------- <br /> stance to . <br /> 7 ( ) F ------ Total Length ��. <br /> - Length of each line_�.��___------ - -------- <br /> LEACWINCs LINE I No:of t i es._' -----#------- ----- i I <br /> D' Box - Type FilterJM'i�telQly: 3- 4 _-*_Depth Filter: Materia) ---0�---------•------------------•---- <br /> _ ; <br /> i <br /> Distance to neatest$ Well. >`±- = --�~ Ori ation Property Line-5________ ___ <br /> 1// Diameter,. _ - Number ---___-__kt- - Rock F' led Yes o <br /> SEEPAGE PIT Depth 1 j/ 1 = /� i , rr <br /> Rock.Size __- - -�--- f + <br /> Water Table Depthr'� r f I 'T� <br /> • Distance to nearest:;Well ---An '----1�_-:---- Prop. Lihe _..--------•---------- O . <br /> r. i— T f ,/ 1 <br /> REPAIR/ADDITION(Prev. Sanitation Permlt# ------------------------------------------- Date ------------ ----------- <br /> } <br /> --------------- <br /> Septic Tank (Specify Requirements) ------------- o= ----------------------------,-------------------------- <br /> Disposal Field (SpLify Requirements) --------------------------------- <br /> --------------- <br /> -------------'--- { <br /> ----------------------------------------------------- ------------------------ <br /> € <br /> 1 ,(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 licen- <br /> sed agents signature certifies.hhe 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.sub'e t1d Workman's Compensation laws of California." <br /> r <br /> ii SignedJ - <br /> _ � �L ----------- ------------------------------------ <br /> � <br /> Owner <br /> IB _____ ------- •-------------------------•---- Title - -------------------- i----- -----------------.....--------------------- <br /> ,'jf (Iffotihet than owner). <br /> ll r FOR DEPARTMENT USE ONLY ' <br /> i. 'f <br /> - -- . DATE _ .�_ `. <br /> f APPLICATION�A-CCEP,TED,/k R� 1------------------ <br /> BU <br /> ------- --- �� DATE <br /> w BUILDJN.G.PERN1l.T IS UED_�✓��-- - --------- - :-:.____:: _ _.� �.� <br /> COMl�E1:TS - ', <br /> ADDI fIONP L ts� f _ 4 1'� . <br /> r ter!'✓ - - r , , ... <br /> f __ • _.._ __ -_ <br /> 7,- � �' -------------------- ---------------------------------------- <br /> f ' - -` = <br /> - -- - - ----- - - - <br /> r --'`, ------ --------------------------------- ------ a— �r <br /> :- Final Inspection by:-_;---::f��-- ------ - - -- ----- -- -- <br /> -- -----------.Date ----- - <br /> f SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Coly <br /> E. H. 9 1-'b8 Rev.6M <br />