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y FOR`OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. . �.` 1�° ; <br /> ................................................... (Complete in Triplicate) <br /> ............................... �f <br /> ��. Date Issued <br />-......._............. <br /> This Permit Expires 1 Year From 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 ....... s:.;':�1�.�. 511 �................................CENSUS TRACT ..................... <br /> ..:._ <br /> Owner's Name �.__ 1E fJE�-.T-- O(V-N..... ............................----- --.......:.....................Phone ........................ .... <br /> Address �+ .- <br /> .... �1- P. % V_ . .............. ...................... City -- ��.p�STO... ....._.....------............ ......... <br /> -.2s7 � .:.. �= !. .._... <br /> Contractor's Name -------.........�L501V......................................................License # ..__ -•-- Phone <br /> Installation will serve: Residence❑ Apartment House Commercial❑Trailer Court•❑ <br /> Motel ❑Other ...........................•-------•-•• <br /> Number of living units_____________ Number of bedrooms ............Garbage Grin-der. .............Lot.Size,--------------------------------------------- <br /> Water Supply: Public System and name ------------­---------------------- ---'.f - - ..... Private (3Character.of soil to a dept► of 3 feet:_ _ SandT❑ -Silt.❑ Clay ❑{ Peat❑ Sandy-Loam=(]; Clay Loam ❑ , <br /> Hardpan ❑ Adobe ❑ FiIIWaterial ............ 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.)i� <br /> NEW INSTALLATION: (No septic tank or seep a pif00Mitted if 'ublie sewer is available within 200 feet,): t[ <br /> Liquid Depth -- / .............G <br /> PACKAGE TREATMENT [ ] SEPTIC TANK. Size:_.. ._-. . ..�d-x-• --------= _ <br /> 1 . Material <br /> f� TypePJ ... '0�1VC� No.. ComP artments <br /> Capacity /`�.._ . _ <br /> c <br /> r <br /> Distance to nearest: Well SQ....................!..Foundation ... 00 .......... Prop. Line ...................... . <br /> LEACHING LINE No. of Lines __. _--- Length of each line-___7:57.............. Total Length ..._�.��- •-- -••-•-- <br /> �'5 Type Filter Material AQ.Ce�•-•Deepth -Filter-Material.........._ <br /> 'D' Box -•��•----... ,... <br /> t r <br /> 'fi Foundation �© O4'` Property Line , v} <br /> Distance to nearest: Well ..:.�?�..:..- -- -- ••... ............. <br /> SEEPAGE PIT Depth f.__...._,^ _l Diameter��x..._ ..... Number ''_��- -••••• Rik filled Yes Er--No Cj <br /> __� <br /> c� r <br /> Rock Size':1. -` <br /> Water Table Depth _. �:---•---•--•-----•----... .�_.�..�: ..::---... <br /> Distance to nearest: Well ....Foundation -------------------- Prop. Line ........_.... ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------••----------•--•-•------------••-•---- Date ..................................I <br /> i <br /> Septic Tank (Specify Requirements) ------------------------------------ ........7----------------- <br /> Disposal Field (Specify Requirements) ............... ---------------------------•---••---- ........ ------•- -• -. <br /> .................................................. <br /> ............•------- ------------- >.-----_-------•----------------- <br /> -- .......................... ........... <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 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 followings <br /> "I certify that in the performance of the work for which this'permit islissued, I shall not employ any person in such manner <br /> as to becarqe subject to Work pn' n laws�of California." <br /> ._ -� - . <br /> '` .......__ Owner <br /> Signed <br /> BY - ---_.. Title .......................................................... ........ <br /> ........................ . <br /> (If other than owner[ <br /> FOR DEP NT E ONLY <br /> APPLICATION ACCEPTED BY ..�t.K` D`----------- --- - --• •- -- - .P.••__....•__-•- <br /> ........•-- DATE ._..------..—I`..7�j--- - --------- <br /> BUILDINGPERMIT ISSUED ---- --------........)fA-4;4Q. ..................................--•---..................­DATE ---------......------...................... <br /> f ADDITIONAL COMMENTS ...............................................••--:.._...:: <br /> ---••--•---•----------•--------•----------- ....... <br /> - . _. . <br /> ..................... <br /> ' s <br /> ....................... <br /> ............................................ ------ <br /> : - .._........ __•_.__.._..._...__..........__......_:....A._..__.__ — <br /> _ ................ <br /> �` , � ` <br /> Final Inspection by: -/..- r` - -••----- <br /> Date _.. ................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> .,. 7172 3 2\1 <br />