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v FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br />.........................._.�..._......-..�.........- s"- /SSS <br /> (Complete in Triplicate) Permit No. ...7............... <br /> •................................................ ...: <br /> d I �� <br /> Date Issued .3`. ^ 7s� <br /> ...............-.. This Permit Expires 1 Year From Date Issued Da •-••-••• <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 <br /> egulations:JOB ADDRESS/LOCATION Y ........ sx CE <br /> - - -- .,...,. ��:. �: NSUS TRACT .............. <br /> r � , <br /> Owners Name �� ( t <br /> Phone ... -.•,.. . _ . . f <br /> Address .............. ....... ............ ... --••.. City _.f./..�G? .........._. ......... <br /> .. . . <br /> Contractor's Name _. •---.. . .. . -.... .. fin - --.License # �. / 7_ Phone ...�1 -.fl.��. <br /> Installation-will serve- Residence XAportment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other ---------------------- <br /> Number of living units:---- .. -.- Ngmber of bedrooms ...-.. _Garbage Grinder ..__ ------- Lot Size <br /> .......... <br /> Water 5uPPIy Public System and i . <br /> aq e ........................................................._.................. --.....- ..--•--••..........-....Private <br /> Character of soil to a depth of 3 feetv SandX Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 <br /> Hardpan [D `Adobe ❑ Fill Material .. ......... 1f es, <br /> Y type .... <br /> (Plot plan, showing size of lot, location of. tystem in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW..INSTALLATION: (No ieptic tankorseepage pit permitted if public sewer is available within 200 feet,} _ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK i ] Size....... ............... ------- ................ Liquid Depth .......................... S <br /> # Capacity -L-�ap-.,.. Type P-zt4g-.. Material.-ifo.vL-vtF-*._ No. Compartments ...:fir........... <br /> Distance to nearest: Well ........57.....................Foundation ........... Prop. Line .__.s ............. 6 <br /> LEACHING LINE No. of Lines . Length of each line..---._..�_Q............. Total Length ............... <br /> V Box . Type Filter Material _....�.. ....Depth Filter Material 1.1................................ °5 <br /> Distance to nearest;-Weli—�..................... Foundation ........................ Property Line ........................ % <br /> SEEPAGE PIT [ ) Depth ...................I Diameter ..... ........... Number -------- ....... Rack Filled Yes C] No ❑ O� <br /> Water Table Depth .-> } ..Rock Size <br /> Distance to nearest:;Weli ..................................Foundation _ -_..-............ Prop. Line -_------- ......... <br /> REPAIR/ADDITION IPrev. Sanitation Permit d/` ... ........................................ Date ..................................... <br /> Septic Tank {Spec;fy Requirements) ............... :: '_,_ .................... .............. .--------- p <br /> ..--.... I <br /> Disposal Field (Specify Requirements) -•......1-.........---------------- -••••------...........- ....................... .................................. <br /> ................. ........................................ --•--....... ........................ ........................ <br /> _.. _ . . . ........ ...� .;..-- .._........_.r. Y�. - ......- _, �- <br /> - ' IDraw exxi_Ing 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 R6#—QIations of-fhe-San Jo"'aqw"ii'Locdl'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 parson in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ---......�-------------------_-..-•---••---....•-•----•-............•---•---•----••-••....------ Owner <br /> ll?Vt41e $I <br /> Sy ...- --------- . ..... .......... Title ...................... <br /> -- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ._. ------- -----------••-•------------•-------••---•--•-....--• ----------• DATE ..37 6�_�._J5.......••. ... <br /> BUILDING PERMIT ISSUED ---- - .......-..............------------------- <br /> ........... <br /> .----------------------------------------- <br /> ..DATE -----•----- ............................... <br /> ADDITIONAL COMMENTS ......-•--•-------------•----•.....--•-•----....--------------...._•--,......... <br /> ................................ ..._ ---------•--...........---••--••--------.....----------.......------........._....._..---------•----•••- <br /> ---•---------------------------------------•----•----.........--•-•---.•....... ...........79­46--,lj�---- -•-.. <br /> FinalInspection by: -•-•--•• ... . .. .. --•---... .................................... ...............................Date ...........� .....-----.....-.......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> e u 13 24 , •in n_ ru <br />