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FOR OFFICE USE: :i <br /> P - <br /> f If p �. A PLIC ON FOR ..SANITATION PERMIT <br /> ATI <br /> --- �-- -- „ <br /> {Comple`fein Inplicate)�' - `""" - 3 <br /> I!------- This Permit Expires i Year From Date Issued 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 applicatQ is made in compliance with County Ordinance No.1549 and existing Rules and Regulations: <br /> JOB ADDRESSAOCATION '�., p .. - ----------- --- _-__-------CENSUS TRACT <br /> Owner's Name ---_- '� - �` � - h F <br /> ------------------ <br /> - -- -•------- ----------Phone ---------------------- <br /> Address -------------- '� ( _ :(-!?_'cJ Cit--------------- <br /> Contractor's Name -J_-- _ �j- �_ /' _ <br /> _ L�`�-+ License # lS- - Phone ------ --------- -•------ <br /> Installation will serve:' Resident - <br /> /J partment House❑Commercial'OTtail�r—Court-';❑ <br /> d; <br /> Motel ❑ Other <br /> -- ----- - -- <br /> Number of living units:--------- _- Number of d`rooEr <br /> ----- --- - ----- -- <br /> N1,1 --_-_______GarbagekGrinder:�14��-��l Lot Size',---Water Supply: PublicSystem and name _-- -_ _--- // ^^ ^--------i-_•-------- ----Private----- C cJ----Character of soil to a,deptf� of 3 feet: Sand' Sift. Cla s <br /> ❑ Y ❑ Peat❑ llSa��ndy LoamF❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material•------------ ff es a __?-,:Y____':�.-!_------- <br /> (Plot <br /> Y ,tYP ------ <br /> f <br /> (Plot plan, 'showing size of lot, location of system in relation to wells,-buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (N� septic tank or Xeeage pit permitted if public sewerisavailable within 200 feet,)J,� Q <br /> PACKAGE TREATMENT [ j SEPTIC TANK 14 <br /> 'ze____ �ID t----- _ _ ---___.- Liquid Depth /`Ca acit Yp <br /> p Y T e_ -- Material:"�- _ _ <br /> _ � P "":___ o:"'�ompartments __. .__ <br /> ------- <br /> �' Distance to ne Frest: Well __- _--_- Foundation { <br /> J <br /> IM - - - =�-------_--- Pro Line __ <br /> LEACHING LINE [ No. of Lines'-gip`-� <br /> ___--____- Length of ch line._`'- - Total Len th 4 <br /> �I <br /> 'D' Box -,- - /' �t <br /> ;Type Filter Material f�N-_--Depth Filter Material <br /> F , --------------------- ---•------ <br /> Distance o nearest: Well- ----------- Foundation Property Line <br /> SEEPAGE PIT [ Depth ------ Diameter ,, _- ___ Number -----C --__ Rock Filled Yes No ip <br /> +spa. _ .. 4 t . VV1 <br /> Wad er Table`Depth .i 9- ----Rock Size <br /> Distance to nearest: <br /> � Well --______-.r--- -- :- _-_-_--_Foundation --- _ ) <br /> Prop. Line r <br /> --------- <br /> , <br /> REPAIR/ADDITION(Prev Sanitation Permit#1- ;------------------------------------------ Date ----------------- <br /> ----------------- <br /> Septic <br /> ---- .----------------------_-_-Septic Tank (Specify Req'uIirements) _____.--_'__. <br /> " <br /> - ------------------------------- <br /> Disposal Field (Specify' Requirements) ___i <br /> - <br /> --- ------------------------- <br /> ------ <br /> -------------------- - -- -- - - -- - --- - <br /> ------------------------------------------------------------------------------------i__--- <br /> ------ --- <br /> --------------------------------------------------------- <br /> (Draw existing and required addition an 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 following: 0, <br /> "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to W Uman's Compensation laws of California." <br /> Signed -- Owner <br /> BY - "' ) Title <br /> - - <br /> (if other tha oIIw r <br /> �I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ rr <br /> - - - -------- - ----------- ------------ -- - ------. DATE ---- - -- -- -- - -4---------- - - <br /> BUILDING PERMIT ISSUED'`'- _---- -------------------- -------------------------- <br /> �, DATE ---- <br /> ADDITIONAL COMMENTS _A1- •- •. <br /> --------------------------------------------------------------------------------=--------------------------- <br /> ---- - --------------------- <br /> -------------------------------- <br /> ----- --------------------------------1----------- <br /> ' ' =fid �` 4v Pf f �{,� = <br /> Final Ins ect-- - ----- ---------- - I <br /> - ---------------------------------------------------------------- ---- -------------------------------------------------------------------------- <br /> iI ----- - --- <br /> p ion by: ----------- J, , <br /> -� -�--------------------------------------------------------------Date ----- -�. )_7.1 1 � '��� 1 <br /> K SAN JOAQUIN LOCAL HEALTH DISTRICT ( f <br /> O <br /> E. H. 9 1-'68 Rev. 5M <br />