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FOR OFFICE USE:-- APPLICATION FOR SANITATION PERMIT <br /> , <br /> _t Permit No. ___ __ __-______P <br /> ----- ------ ------- = ------------- ---------------- (Complete in Triplicate) <br /> ---------------------------- <br /> ----------------------------- <br /> �-, Date Issued -_6-"<<f-�---.- <br /> ------------- ------------- ----------------- ------------ <br /> This Permit Expires 1 Year From Date Issued <br /> 1/.,i <br /> Application is hereby-n)ac)',to the San Joaquin Local Health District for a permit to construct and install the work herein j <br /> described.4his application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION -- -- - --------�------ \Jl-N-E=—=--------`--------------CENSUS TRACT ------- - - ----------- <br /> -- ------ ----Phone ------------------------ <br /> Owner's Name � p-R.61Z----------- L ------------ ------ ------ - <br /> � ---- ---�-- -----Vf/V-t ------------ -------- city ---- --------------------------•--•---•-- <br /> Address ----- � W - <br /> -----.License## ------- -=-------------- Phone ------------------------------ <br /> Contractor s Name ----------- ----------------------------------------- <br /> Installation will serve: ResidBnco ❑ Apartment.House-0_Commercial::❑Trailer_Court- ; ] <br /> f <br /> el E Qther ------------------------------------ ' s <br /> .t / ee <br /> Number of living units:__- ---____ Number bedrooms�- _..Garbage Grinder _---___.-__ Lot Size .--1T�-��-��-------- � <br /> Water Supply: Public System and name ---'------- ------------- �' Private <br /> --- - -�---- ------------------- <br /> Character of soil to a depth of 3 feet: Sand'❑__ Silt❑ Clay❑ Peat❑_•_,Sandy Loam ❑i Clay Loam <br /> Ado a ❑' Fill NMateriai _ - - --------- <br /> E' <br /> —-�- <br /> - - ! `If yes type <br /> (Plot plan, showing size of lot, location of system-,in elation'`to' wells, buildings, etc.) must be placed on reverse side.} <br /> �' rm r <br /> NEW INSTALLATION: (No septic tank or seepage pit, ermitted-i•f. public sewer is•avail' lewithin 200 feet,) 1n1 <br /> --- <br /> l..~.�-� Size--------------='�---- ----- ------- -- Liquid Depth ---------------------.-•--- <br /> PACKAGE TREATMENT [ ] SEPTIC TANK:[.j �_ . <br /> I�� -� o. Compartments� <br /> Capacity -------------- ---- TYpe^----- -------------- Matenal- ----- ---� - - p -----------•-•--•----• �[ <br /> _ fI I l <br /> Distance to nearest: Well ------ _:-------------------- <br /> '------Foundation -_.- .--_-.---1------ Prop. Line ----_-----------_---- <br /> LEACHING LINE [ ] No. of Lines --------------------- -- Length of each line-------------'--- Total Length .-- ------ \�• <br /> 'D' Box ------------ Type Filter Ma erial --------------------Depth Filte' M terial -------------------------------------------- <br /> -:, <br /> -- ---------------------------------------- <br /> -:,-,5 Propent Line, k ----------- <br /> ",;,,_j; �pistance_to.,n�arest:-Well._------- ------------------ p fiY � <br /> SEEPAGE PIT }[ ] ® Depth -------------------- Qiameter Number --- ----. -�-- ---- Rock Filled Yes El No <br /> Water Table Depth Rock Size i-r`= <br /> --------------------- <br /> Distance to nearest: Well ---------- -----------------------------Foundatio�t._------------------ Prop. Line --------------.------- <br /> f REPAIR/ADDITION(Prev. Sanitation Permit# .------ --------------------------------- <br /> Date --------->-1--------------------- <br /> 1 <br /> w 11� �`i- <br /> y' Septic Tank (Speci#y Requirements) ------------ lP/ - -�``� ------ <br /> Disposal field [Specify Requirements] ------ - -- � <br /> i <br /> ---- �- � r ' --------------------- ------------­--------- <br /> ----- X1'-1 z- <br /> QQ.. AC - PT Tf - , <br /> - <br /> r y (Draw existing and required ad i#ion on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be don <br /> e Min accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Loccl Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certij <br /> t i'n the perform of t work for which this permit is issued, I shall n t,,employ any person in such manner <br /> I as to b 'subject to Wor an's mpensati.on laws of California."Signed p ----------- <br /> ---------------------- <br /> --- --- Owner <br /> if other <br /> `_ Title --------------- <br /> ------------------ <br /> By - - <br /> i ( than owner) <br /> f I EPARTMENT USE ONLY <br /> Vil <br /> ' APPLICATION'aACCEPTED BY ------- -- - -- ------------ ------------- ------ DATE - -I - <br /> ------------------------------ - <br /> x BUILDING' PERMIT ISSUED ----------- -- DATE ----------------------------------------- <br /> i - -d-------------- <br /> ADDIT,IONAL-COMMENTS -----------=--- ------------ �-I --- -------------- <br /> ---------- <br /> - <br /> �' -- ----------- <br /> r _ <br /> Y -- ---- ----------------------- <br /> ", 1 `A i� ------- `------- ------- � - ---- � ` <br /> _ ___ _ <br /> ---- <br /> Q to .-._ <br /> Final Inspection by: -- '------- = a <br /> --------------------- <br /> AN JOAQUIN LOCAL DISTRICT <br /> E. H. 9 1-'68 Rev. 5M -� <br />