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4v .41 <br /> FOR OFFICE USE: APPLICATION FAIL-SANITATION PERMIT �f <br /> F ----- ----------- ---------------------------^----- I <br /> (Complete in Triplicate) Permit No. <br /> - ---------- - <br /> -- - 3 acs-'73 <br /> I Date issued ___-.._�----------- <br /> ---_ This Permit Expires 1 Year From Date Issued <br /> Application is hereby madeto`th San Joaquin Local Health District-for a-permit to-construct and install the work herein 1, <br /> described. This applicafion ,iis.-n de"_in.complidnce"with:County Ordinance No._5�i9 and ezisting.Rules and Regulations. <br /> ii L� <br /> JOB ADDRESS/LOCAT�pN _31011------F ---H_f�l -- - /� ---- --CENSUS TRACT ---- --- ---�-- <br /> '. <br /> Owner's Name ---�.l-�_�1.��-:-- - 19_�-1�_�- - - `._,•' -- ------=-�--- ---------------Phone -- -- -------------• ------------ �. <br /> Address - _=l 1-- ---- l� 114. /2 ------------------ - <br /> ----•--. City ---- •- <br /> _�4y --- - ----------------------•-•------ <br /> . _ ._.._._._�. . --Li <br /> Contractor's Name / - _ :W � fes' <br /> �_ w _... cense# Phone'_ <br /> Installation will serve: Residence A artment House❑ Commercial,[DTTrailer Court F <br /> Motel ❑ Other ---------------------------------------- <br /> Number of living units:----- Number of bedrooms _3----Garbage Grinder __ Lot Size .../ ---------- ----:.----= <br /> A. f <br /> ' ``-- s -}- - ------ ------- ----Private <br /> Water Supply: Public System of 3 name ------------------------------------ -------------- <br /> Choracter of soil to a depth feet: ! Sand❑ Silt❑ Clay (] Peat❑ Sandy.Loamy Clay Loam ❑ i <br /> Ha`rdpon,_Ej Adobe-'❑ �--FilI-Materia!— If-yes,type _____________________ <br /> (Plot plan, showing size of lot, location ofl system in relation to wells,_buildngs, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Ilk <br /> TREATMENT [ } SEPTIC TANK ['J Size-----------------------------------' Liquid Depth ----------------- ------- <br /> PACKAGECapacitY ----------------� P Material. o,` Compartments �I <br /> e ---------- <br /> t <br /> Distance to nearest: If Foundation =-__-__ Prop. Line -----------___________ <br /> LEACHING LINE [ ] No. of Lanes --=----- _.--- Length of eachline-------------------------- -Total Length -------- <br /> _.. _.D-B65(- __ .Type Fi ter-Material --------------------Depth Filter -Ma erial -------------------------------------- <br /> Distance)to nearest: We ------------------------ Foundation --_ Property Line ------------------ <br /> Depth ----PIT [ ] Depth !�.----- Di eter ________________ Number ----------------------- - Rock t=illed Yes ❑ No 0 .1 <br /> 1. <br /> Rock Size ----------- --------------------- <br /> ion---=-__-. ,--~===---------•-------------: -__--_:; _..._� .__ '-' - -- . <br /> Distance Ito nearest: W --------------------------------------Foundation ---- Prop. Line -------- ----------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit F# _____ Date _-____--- --- ------------1 <br /> ------------ <br /> > l <br /> Septic Tank (Specify Requirements) ------------------ <br /> o- Disposal ,Field (Specify Requirements) ------ <br /> ---- � j r--__ �— -- <br /> Icl <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that 'lie work will be done in accordance with San Joaquin <br /> t County Ordinances, State Laws,i and Mules and Regulations-of the San Joaquin Local Health District. Home owner or licen- <br /> I <br /> sed agents signature certifies the,following: <br /> "I certify 'at in he perf m nce of th work for which this permit. is issued, I shalt not employ any person in such manner <br /> as to be e s iect to ma_n's C pensation laws of California." <br /> Signed - - ----------------------- Owner <br /> gy - - - ------------------------------ <br /> ` Title ---------------- <br /> i (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY '__-f---�-1°'� - - --------------I DATE __��-- - 7-- <br /> PERMITISSUED -------=---------------------- ------------------------------------------- ----------------- DATE - <br /> ADDITIONAL COMMENTS•-.---' --- - --- - .__ __ --.--------------------- _�----______---__.r <br /> 1 y y %s -___ <br /> ____. _______ ____ ------------------------------------------------ -____ <br /> ---------------------------------- <br /> ----� ------ - ------ -- - --- - - -•— <br /> fryer <br /> Final Inspectionby. �� - - Date <br /> SAN JOAQUIN LOCA(; IEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M <br />