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T FOR OFFICE llSE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ................. ................. <br /> A01 (Complete in TrI04ate) Permit No. _-- ........ <br /> This Permit Expires 1 Year From Date Issued <br /> Date Issued <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 opptication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations y <br /> JOB ADDRESS/LOCATI N 4V .......C1. _[.� -..-CENSUS TRACT Y� <br /> Owner's Name ...... ... , - ------- •-•-•-•................••-•----- Pho...................................... ne .............-..................... . <br /> Address ........'.fid. -J57f..... C.�� �. -••-•---------•--•---••-•------•--. city .. .... ................................................... <br /> Contractor's Name .t....................License # 2 Phone <br /> Installation will serve: Residenceo Apartment House 0 Commercial❑Traller Court 0 <br /> Motel ❑Other_ <br /> Number of living units:_ --- Number of bedrooms ....I.....Garbage Grinder A-&?----- Lot Size .:l �.�`a..14_.�.�. ........ <br /> I � P <br /> Water Supply: Public System and name _-- -4-__ (�a. ---.C°p?"........................................................Private ❑ <br /> Character of soil to a depth of 3 feet Sand❑ Silt❑ Clay ❑ Peat❑ -Sandy Loam ❑ Clay LoamA <br /> Hardpan❑ Adobe❑ Fill Material ............ if yes,type............... ............ i <br /> (Pfo?''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,) I <br /> PACKAGE TREATMENT { SEPTIC <br /> TANKAe Size......1- -U --- -------- Liquid Depth ........................... +' <br /> Crapo ity - .... Type ----------------•--- Material__t�e-s+s7.w No. Compartments -- '....Vt�' <br /> Distance to nearest:.,,Well ...._ - - - ..Foundation ..... . -`•-----.. Prop. Line ._�a................ <br /> LEACHING LINE No. of Lines --- <br /> ---`------.-- Length of each line.-..--.-----------------.... Total Length ............................. <br /> D' Box ...::�....... Type Filter Material __._---------------Depth Filler Material <br /> Distance to nearest: Well •.......:.............. Foundation --..----------.-----.--- Property Line ......................... <br /> SEEPAGE PIT ] Depth _... .......... Diameter ............... Number -----............. ......... Rock Filled Yes ❑ No 00 � <br /> Water` Table Depth ------ ................................Rock Size ------------- ........_ . owl , <br /> Distance to nearest: Well .........................................Foundation .-...._:--- ..--•. Prop. Line ..........._....____.`% i <br /> <- � <br /> REPAIR/ADDITION(Prev. Sanitotiori'Permit#''------ --------•--..•-•.---.---- ...::..:..-Date :.-::-W--------------:____--•-) <br /> it � - <br /> Septic Tank (Specify Requirements) ................._-.----_---_ :...._..•--------....._.....................•--•••......-••....:......._._... <br /> Disposal Field (Specify Requirements) _i... ......................------------------------------------------------------------------------------ =-----?--• f <br /> --•---------------.......--.......-------------------------------------------------------------------..... -••----------------= _. -----._ ...... ................. <br /> ----------------------------------------------- ---:•- ------------------------------------------------ ... -------._.............................. i <br /> {(Draw existing and required addition on reverse side) <br /> I hereby certify that l have prepared this application and that the I work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, an'd Rules and Regulations of the _San Joaquin Local Health District. Home owner or liten• <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 ---------------------- --------K------------------- ............. Owner <br /> BY �F- IC ----------------------------- Title ----------------------------------------------- .--- <br /> (If other than owner) <br /> F99 DEPARTMENT USE ONLY j <br /> APPLICATION ACCEPTED 6Y ........ DATE ...` ------------ ----- <br /> APPLICATION 7,�~.--_._ <br /> ... ..... ... .............................. .- - <br /> BUILDING PERMIT ISSUED ............ ....•-----•-- --•------•----•-• -----•--..-_ ...... ......................................DATE .-.: ..........................----..-..... � <br /> ADDITIONALCOMMENTS .............. .....:.............................................-..................---.......•• . ...... <br /> i <br /> --------------------•---------•-----•---•-----------------••---•---••--•--•. ----------------------------.........................._.......................................................... ...... <br /> .... --- ` ------------- - .............-----------------------.....- -.................. <br /> finalInspection by: ----- -- - ---------------------------------------................................Date .. �✓/ .._........ <br /> EH 13 2L 1-68 Rev. 5M N JOAOUIN LOCAL HEALTH DISTRICT 8/74 3M <br />