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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ----------------- Permit No. .-.7�_-//2 <br /> 4Camplete in Triplicate) e <br /> ---------=----------------------------------------------- <br /> Date Issued ----- --�----•:-• <br /> r- <br /> -------------- <br /> ' Prmi+'Expires 1 Year From Dat Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here n <br /> described. This application is made in compliance with County Ordinance N . 549 and existing Rules and Regulations: <br /> JOB ADDRESS/Lt <br /> -� <br /> JCATION .--f���/----�'1' -- <br /> --P�IL--- -------�'-�----------------------- ------------CENSUS TRACT ----------------=------ -- <br /> ��/ dZ cS <br /> Phone = <br /> Owner's Name _ �PS------------ -5 /----------- <br /> Address -------------------------------------------------------------------------------- City -- - F� ----Zfa 1�------------- <br /> Contractor's Nam /�� •--�. � �4-/e- Phone <br /> -°--------License #���-- --- i-- <br /> Installat DnMiil!i serve: Residence,]Apartment House❑ Commercr tl [ Trader Court '0 <br /> Motel ❑Other -------------------------------------- ---- <br /> Number of living ur'lifs:_---.------ Nu, -- l.er//O.-._ Lot Size --� ��" r------ <br /> � � f �_--Garbage Grind, <br /> Water Supply; Publi-System"and name --------------------_--_------.- i -_-_-----Private <br /> Character of soil to 8depth of 3 fere Sand Silt❑ Clay ElPeat© Sandy Loam ❑ Clay Loam ;❑ <br /> Hardpan [[ } Adobe ❑ Fill Material --_-------- If yes,type ---------------------------- <br /> (Plot plan, showing size of lot, location�of sm ystein relation to wells, bi ridings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION. p <br /> , (No septic tanis or seepage pit permitted if public sewer is available within 200 feet,) r b <br /> i. y, <br /> r PACKAGE TREATMENT [ SEPTIC TANK'[ I Size-� <V__---------------------- LrqOp,uid Depth -"/---__-----..- -- -- <br /> CapacityVAl�v- Type%�, - Materia���No- Compartments -Z______________�.. <br /> Distance to nearest: Well j__- -- -----------------Foundation -,14 - ------ Prop. Line _.o------------ <br /> LEACHING <br /> ---_-_---.-- <br /> - ------ Tof'al Length .--.1'r"...-------•_1-- <br /> LEACHING LINE No. of Lines -- _____ ________ Length of each line--- '--- a <br /> D' Box y---- Type Filter Material -----Depth Filter Material 107-le----------.-------•.--------•--•- <br /> Distancee to nearest: ell -- ------------- Foundation ---/41-----_---------- Property Line - ------------ -- <br /> i <br /> SEEPAGE PIT [ ] ept -------------------- Diameter ---------------- Number --------------------------Rock Filled Yes CO] No KD . <br /> z Water Table Depth ----------------------------------- ------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------------------- -. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _.- ------------------------------------ Date _-----------------------�-'-----I <br /> Septic Tank (Specify Requirements) -------------------------------------------------------- ------------------------------ -----------------------­ <br /> tE <br /> -------- -----------------,..------------------------ <br /> t Disposal Field (Specify Requirements) -------------------------------------------------- -------------------------------------------------------------------------- -- <br /> 1_71 <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 �+vill be done insaccordance with San Joaqu n <br /> r County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licei i- <br /> sed agents signature certifies the following: <br /> "1 certify that in the performance of the work for which this permit is issue, I shall not employ any person in such manna <br /> as to become subiec to W r an's¢lCompensati.on laws of California." <br /> Signed -. �► -------------------------------------------- Owner <br /> BY - - - - ------ ---------- <br /> Title --------- <br /> (If other than owner) <br /> ) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -----46) �- - -•--- ------- ----- -------------- ----- ----------- <br /> DATE ----- <br /> BUILDING <br /> ---BUILDING PERMIT ISSUED --- -------------------------- --------------------- - --------------------DATE ----- --------------------------------- -- <br /> ADDITIONAL COMMENTS - ------------ ----------------------------------------- --------- <br /> -- - --------------------- -------------------------------------------------------- ------_--------------------------- - _----------------- -------- <br /> ------------- :�:---- - ---- <br /> ----------- -------- - - - - <br /> Final In. pect*n by: --------- ------'------------------------------------- ---• ------------Date ' <br /> SAN JOAQUIN LOCAL HEALTH DI RICT <br /> b, E. H. 9 1-'68 Rev. 5M ,, `� <br />