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FOR OFFICE US`------ --- --- - <br /> E: APPLICATION FOR SANITATION PERMIT <br /> ---------------------------r_---- - Permit No.7a_ <br /> (Complete in Triplicate) <br /> --- <br /> - - ------ - - ---------------------- <br /> Date Issued <br /> -----------------------------------------:--------------- This Permit Expires 1 Year From,Date Issued <br /> Application is hereby made to the San Joaquin`Ldcal Health District for a permit to construct--and install 'the work herein <br /> described. This applicat'ion'is made in compliance with-County, Qrdinance .No. 549 and existing ,Rules and Regulations: <br /> - <br /> JOB ADDRESS/LOCATION . 4;w------ _• _._. _/ ,_ _I _P/QT------- A_�-_-_------__CENSUS TRACT <br /> Owner's Name i�"�Q G . = '(.tet t.�[-Q F7 - Phone <br /> Address -----12—Pa S1----Is-------A<7_RP©RT-- VV A__X----,r. City ----�rc-A--------------------------------------------------- <br /> Contractor's Name C�i __-�1.-f aMl _�?_ --_ _PT�:C-. V-_.License # 2 �-Z - --_ Phone ______________________________ <br /> Installation will serve: Residence 2Apartment House❑.Commercial ❑Trailer Court i❑ <br /> Motel ❑Other ---------------- -------------------------- ^^� <br /> Number of living units:_______-_ Number of bedrooms _______Garbage Grinder `-Y�'-_- Lot Size .[.1>__Q �� -_.' -_- ` ...... <br /> Water Supply: Public System and name ------------ --------- ------------------------------------------- ------------------------------------------Private lii� <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ;❑ <br /> Hardpan ❑ 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.) X1 <br /> NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE-TREATMENT [ ] SEPTIC TANK --------------- Liquid Depth _:_ .......... <br /> Capacity /2707 0-,__ Type N_ECAS7­Material__4r_VN(RT__No. Compartments -------- <br /> -,Distance <br /> -_-__.w,Distance to nearest: Well ____ ., _�" -------Foundation _,/Q "+"___-__ Prop. Line -'*' <br /> LEACHING LINE V11 No. of Lines ___'_ _ <br /> _ �,:----------- Le�n`gth of each line,-..--. - ___.___.._ Total Length ------40____....... <br /> 'D' Sox ) Type Filter Material _A_0_!�-K_0epth Filter Material -------- -- ---------------•---- - <br /> Distgnce to nearest: Well -----%!1,O----------- Foundation ----/V-_.......... Property Line --- _•.--___ <br /> L7` ED `Depth -/-')-------- --- Diameter/40 ) 9r Number ----____ Rock Filled Yes No <br /> N - ., <br /> I? _ -�- --;�•- ---•---------,_Rock Size.,��--n;2,/;. --------- r <br /> Water Table. Depth _,.__: �- , <br /> Distance to nearest: Well --------- ------------------------Foundation <br /> '/Q -t" Prop. Line ..5._.-'�"` <br /> 1 <br /> REPAIR/ADDITION(Priv.;Sanitation Permit# -------------------------------------------- Date ---------------------------------- <br /> Septic <br /> -_____-_______--__ _________---_Septic Tank (Specify Roquirements) ---------- ---- ----- ---------•-------- ------- -------•-• -- - - ---- •--- -----------------------••-- <br /> Disposal Field (Specify Requirements) ------------------------------------------------------ ------ ----------------------------------------- ------- ------- <br /> ------ <br /> -------------------------------- ,.... . <br /> ---- <br /> (Draw existing and required addition on reverse side)` <br /> I hereby certify that 1 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 Son 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 bec a subject to rkman's C ; e tion sof California." <br /> - <br /> Signe ---- - --------------- ---- Owner <br /> { <br /> By - --------- - -- --- ----- ` ------- Title ------ <br /> (If other t a o n r) <br /> FOR DEPARTMENT USE ONLY �7 ! <br /> APPLICATION ACCEPTED BY - -- DATE .. < c <br /> BUILDING PERMIT ISSUED - - --- - -----DATE . <br /> ADDITIONAL COMMENTS - ------- ----- <br /> ,. _--- --------------- <br /> ----- - --- <br /> -- --- - - ------------------- -------- -- ----- --- -- - --- -- ------ - ---------- ------------------------- ---- <br /> ------------------------------------- ----- -- ------ <br /> Final Insp -- - - -- ---- <br /> `--------------------------- -------Date ------- <br /> --- <br /> ----- ° <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />