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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT, <br /> I�`»----- .�, .. y---------- Permit No. <br /> Y__ <br /> (Complete in Triplicate) <br /> ---------------------------------------------- <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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION !a4_ �Q LR`" } ------- --------------------------------------------- ---CENSUS TRACT -------------------------- <br /> Owner's Name ------------Phone --46-2_--GV--- ----•-- <br /> Address 2V._0---f------- ----���' � � -----.... City -:57 j�------- ---------------------- <br /> l�� <br /> -1 // S - a- ----------------------------------'License #� � --- Phone -------------------•---------- <br /> Contractor's Name __-..:�C� _------- <br /> L..,. t <br /> Installation will serve: Residence [Apartment House❑ Commercial :❑Trailer Court ❑ <br /> Motel ❑Other -------------------------- ---------------- <br /> Number of living units:--l--"---- Number of bedrooms -J------Garbage Grinder Lot Size" _""l_00.74-"7-- ." <br /> 1 <br /> Water Supply: Public System and:name -------------------------- -------------- ------------------------------------------------- - - -- --_-._Private ❑ <br /> Character of soil to a depth of 3 feet Sand'[} Silt❑ Clay [I -.Peat E] -Sandy Loam E] CIay.Loam;❑ <br /> 1 <br /> .rk Hardpan ❑ Adobe ,ll—Fill Material ------------ If Yes,type --------------------------- <br /> { , = <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"orjseepage pit permitted if public sewer is available within 200 feet,] O <br /> PACKAGE TREATMENT ( ] SEPTIC TANK��[ ] Size-------------------------------- ---- <br /> ---------- Liquid Depth -------------------------- <br /> I I <br /> Capacity +---------- Type -------------------- Material---------------------- No. Compartments ---------- <br /> Distance to, nearest:'Well ------------------------------------Foundation ---------------------- Prop. Line ---------- _---•---- <br /> LEACHING LINE [ ] No. of Lines -------I--------------_ Length of each line------------------------- -. Total Length _-___----__..._.---- y <br /> 'D' Boz .-------------- Type Filter Material --------------------Depth Filter Material -------------------------------------------- <br /> Distance <br /> ----------"--"Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line -------------------­-- <br /> SEEPAGE <br /> -----"-..--___--- --SEEPAGE PIT [ J Depth ------ ------------.--: Diameter --------------.- Number ------ .-----"------------ Rock Filled Yes E] No ❑` <br /> I - F <br /> Water Table Depth <br /> -•---------- ---------------------------------Rock Size ------------------- ------------ <br /> Distance to nearest Well ----------------------------------------Foundation --------------- ---- Prop. Line ---------------------- <br /> r' - <br /> REPAIR/ADDITION(Prev. Sanitation Permit,# ------------------------------------------- Date ----------------------------------) <br /> SepticTank (Specify Requirements) ------ `----------------------------------------------------------------------------- ---------------------•---------------------------- <br /> L✓ C /,{/ <br /> Disposal Field (Specify- Requirements) --- <br /> ------------------------------ <br /> �"�_-� - <br /> (. <br /> ---------------------------------------------------------------------------------------------- <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 San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> -11 certify that in the performance of the work for which this permit is issued, 1 shalt not employ any person in such manner <br /> as to become object to Wo kman'sfCoinpensation laws of California." <br /> Signed -" Cyd - ---------; --------------------------------------------------- Owner <br /> BY --------: ------------------ ------ ----------- <br /> ---- ------------------------------------------------- Title ------------------------:----------------------- ----------------------- <br /> (if other than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------., <br /> \X,.? -""" - DATE _.�e_�2 "f -------------------- <br /> BUILDING PERMIT ISSUED -------------- ----------=------------------------------------------------------------------ DATE <br /> ADDITIONALCOMMENTS --------------]------------------------------------------------------------------------------------------------------------------- -------------,-------.--- - <br /> ----------------------------------------- ------------ ----------------------------------------------------------------------------------- - 1 <br /> ----------------------------- <br /> 1 <br /> ------------------------------ <br /> Final Inspection b I -----------•---------- - ----- ------Date ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT , <br /> E. H. 9 1-'68 Rev. 5M. 4 <br />