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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .................. .....---•--... <br /> Permit No. <br /> .......... ..... •-----------........._.........._...... <br /> IComplete In Triplicate} •..... <br /> F Date Issued .`. <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 /> i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> f JOB ADDRESSAOCATION ..-...L7 .. G�/7 Q E $ <br /> f. /..lJ.. CT <br /> � ...0 NSU TRA <br /> i Owner's Name ... .�//✓ _.//..�cJ...: ..................................... Pone .._.. <br /> t <br /> . ..................Phone ... <br /> Address .......-. 15. ..... .. City <br /> ...................... __.... ..........•...................................•••-•••--•-- ........_....-•-- <br /> Contractor's Name ---------- � 7G----- -------------- ......................License -•.............•--. . Rhone .......... n <br /> Installation will serve: Residence Apartment House] Commercial oTraller Court <br /> Motel El Other-------••---/-- ... :..•----- r i <br /> ve ' <br /> Number of living units:------ ... Number of bedrooms ....._,l .Garbage Grinder .........:.. 1.ot Size ..._ . <br /> Water Supply: Public System and name ....Private 0 <br /> Character of soil to a depth of 3 feet: Sand Silt O Clay ❑ Peat❑ Sandy Loam Ctay'Loam <br /> Hardpan Q Adobe 0 Fill Mnterlal ............if yes, a............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, ate. must be placed on reverse side. <br /> NEW INSTALLATION: (No septic tank or seepage pit permi � public sewer is av ilabla within 204 feet,) ! <br /> PACKAGE TREATMENT SEPTIC TANK[ ]{ ] SX/BX ize.br 1 <br /> _ Liquid Depth <br /> Capacity 1 .. Type ��� aterial... No. Compartments �- <br /> Distance to_nearest. Well ! _- /` % undation�............ ....... Prop. Line ........... <br /> LEACHING LINE No. of Lir es ..-.__--1 .. -__ Length of ach li <br /> !�l D p - ..y._. Tota! length .-. .............. <br /> / a� i�' - ct� '` -- <br /> .D. Box ---�... . Type Filter Material ��- _.Z... e th - ilt r Ma Tial �9 ...... <br /> /1 <br /> Distance ton Brest: Well .-. w /. dation _...� ...... Property Line _:. ..... .......... <br /> ._ <br /> GE <br /> SEEPAPIT - r <br /> . { ) Depth Diameter .......:........ Number .-----------.-------.....-.Rock Filled Yes No 0 <br /> Water Table 'Depth <br /> Rock Size <br /> Distance to nearest: Well .............•­------­---------------Foundation .-................ <br /> -- Prop. Lln® _..•---...r_. ........ <br /> REPAIR ADDITION(P ' mit ......... Date <br /> } <br /> Septic an pecify Requirements) ...:......... <br /> ......----........................... <br /> �. <br /> inents) ----••- [?�.fr -�l: --.�4_3)IS& ,�Z� 1. A.._.._ <br /> Disposal Field {Specify Requirel�D O F ���/ � � <br /> ----- <br /> . ••--••. ------- -• r <br /> -- -- - - -•••-- ... I!!.�...............`........_ .............. <br /> 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, ared Rules and Regulations of the San Joaquin Local Health;District. Homer 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 shalt not employ any persona in such manner <br /> as to become subject to Workman's Compensation laws of California." ,,l <br /> Signed.- --•----- ---------- <br /> - <br /> } <br /> __ � - -------------•--••------...-.-.----•------- - Owner �J <br /> By -..--... yd"? .. ,... - -------------• ---------------- Title --------------- .. ............... <br /> (If other than owneri <br /> DIEPARTMIEN USE ONLY <br /> APPLICATION ACCEPTED BY --�/��.,-- _. I]ATE.,... .. . . <br /> C / <br /> CJ /f"�-7 ...-- <br /> BUILDING PERMIT ISSUED -- ...... . .--. .---- DATE --.......... <br /> ----....--- ...... _. -. .. - <br /> ADDITIONAL COMMENTS --------------!-._...___.-----• - --- <br /> --------•------------------...- <br /> - -----------••- -------------- <br /> ------------------------------•--•- •------- -- <br /> -----------...................... <br /> ----- ----------- --- •---- ....... <br /> --•-- =---...-,.------.-.......------...._.. <br /> Fina) inspection by: -. '�' Date <br /> . <br /> .--... _ --- ...... <br /> EH 13 2h 1-68 V. <br /> SAI•! JOAQUI LOCAL HEALTH DISTRICT 8I7}i 3M <br />