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FOR OFFICE ISE: APPLICATION FOR SANITATION PERMIT �Cua-x` <br /> --•--......._ ._. <br /> .__ .._..... .._._...._. _ <br /> (Complete in Triplicate) Permit No. .......I............ <br /> p f <br /> From ires ? Year rm Date IssuIssuedDate Issued ..�a?�. 1� <br /> This Permit Ex <br /> Application is hereby made to the San Joaquin Local Health District fors a permit to construct and Install the work herein <br /> described. This applicatio is made in complia a with County Ordinance No. 549 and existing Ryles and Regulations: <br /> JOB ADDRESS/LOCATIOtd -.! � a�. f� '. �� d / Qf <br /> '!. fl... +��... .... /� S TRA <br /> Owner's Name ...C. j -�.---- -- C..�...........................................,,........................ ...........Phare C v 1�......... <br /> .... .... <br /> Address K...._ -e. C7.00- 7 .................. ................................ City /y/ :. .----. _ ............................ <br /> Contractor's Name ..._ L� �1..`�.................................License 91 /.x.....---. Phone .......... <br /> Installation will serve: Residence Apartment House 13 Commercial❑Trailer Court C <br /> I Motel ❑Other ..........................•------••---•... <br /> Number of living units:-----/.... Number of bedrooms ..........Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply: Public System and name ........ ................................... ------ ---------• -----•--•-- .......................-Private <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe 0 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 public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK Size..............1.................................. Liquid Depth .......................... <br /> Capacity -------------------- Type -------------------- Mat Lal.................... No. Compartments ...................... <br /> Distance to nearest: Well .......................... ........Foundatio ...................... Prop. Line ....................x <br /> LEACHING LINE [ No. of Lines __ Length of a ch line----------- ............... Total Length ............................0 <br /> 'D' Box ........-... Type Filter Material .... ...............Dept Filter Material ............................... <br /> Distance to nearest: Well ................... .... Foundatio Property Line ........................ [D <br /> SEEPAGE PIT [ ) Depth ____________________ Diameter ....... ........ Numbe ------------------- Rock Filled Yes ❑ No <br /> Water Table Depth ............ ......... ................ ..Rock Size ------------------ ------------- <br /> Distance to nearest: Well .......... ..................... ......Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------ ------ --------------------- ------- Date ......-.....................------) <br /> SepticTank (Specify Re uirements --------- .......... ................................ .....................................-•-----•------------- <br /> Dispos ! Field (Specify <br /> ul <br /> Ry�J , nts) ..... --•-------•- / . - .... ................. <br /> -•/•r------•-- ............... <br /> - _...�lr/\-\ms/. - Y�\/S--./-/.�y.(.-� .+...�... <br /> ......m { -- <br /> `-_TJ__-?----1----�..__. . ----L� � dJ .....-77 .� . <br /> ....__._. .. <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 /> County Ordinances, State Laws, and Rules and Regulations of the San ;Joaquin local Health:Dlstdo. 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 Work n's Compensation laws of California." <br /> Signed - - ------ ..... . ...... ----------- Owner <br /> BY - .................. <br /> Titie .......... .. .. <br /> (if other than owner} <br /> _ NIL FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- --------------- DATE .... -•--------- .: <br /> BUILDINGPERMIT ISSUED ------ --- ------------•----------------- ..... ................F------. ---- ---- -------DATE --------------------------------------------- <br /> ADDITIONAL COMMENTS --------------- <br /> ---------•-------------------------- ------- --------•- - <br /> -- ----- --------------------------------- <br /> •---------------- <br /> ----•----------.--- ----•----------------------------------------------- <br /> ... Date �". 1.�-... <br /> Final Inspection by: -•------ ------• -- .... <br /> EH 13 24 1-68 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />