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FOR OFFICE USE: I -� " <br /> APPLICATION FOR SANITATION PERMIT <br /> - ------------------ ----------------------- � Permit No. ---` <br /> � �j---� <br /> (Complete in Triplicate) - --- <br /> - - - - - ----- - ---------- -- ���.,�7.�. <br /> -._------------------------------------- --------------- + This Permit Expires 1 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 application is made in compliance with County Ordinance No. 549a d existing Rules and Regulations: <br /> r I � <br /> JOB ADDRE=SS/LOCATION .--� �_-Gr,�/�I �'_----6,041y-__ ( ___ , ENS <br /> �-- - - - - US TRACT ------ ------------------- <br /> Owner's Name Wxe_o---------------- --------- ------------------------------------------------------Phone--------------- ------------------ <br /> Address ---- O_1 ��C f_ .efl��fl- r-----------. City d 7II� ---- - - ----- -------- <br /> . Contractor's Name - - 40Pe-7e-'�--------------------------------License #f� i � Phone �l lei <br /> "!'`Installation will serve: Residence [)Apartment House C mmercial [:]Trailer Court *0 <br /> Motel ❑Other,/` r� ---------- z r <br /> ------Garba a Grinder 7=—r-.---- of Size �- e� �_ <br /> Number of living units:_-— Number of bedrooms ___ g --- L <br /> Water Supply: Public System and name ---------------------------------------------------------------------------------------- Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam; -- <br /> . <br /> Hardpan ❑ Adobe ❑ Fill Material ----- ------ 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.) <br /> NEW INSTALLATION: public sewer is available withinf200 �eetJ- <br /> PACKAGE TREATMENT (No se tic.tank or Size: �- L <br /> p seepage pit permute i <br /> i <br /> ( ] SEPTIC TAN ---------------------' Liquid Dept ;Kt---------------- v <br /> Capacity Typ�/� Material. No. Compartments ----Z-------------- <br /> Distance <br /> --._-- _ _Distance to nearest: Well __ ` ---.---_ Prop. Line�>.��-_1_-___ <br /> -��---- ----------Foundation - -_- ------- <br /> LEACHING LINE No. of Lines Z----------------- Length ofdach line __ -'---.-- --- Total Length _ Q - ' <br /> t D' Box - Type Filter Materia' f� epth Filter Material --------------------------- <br /> 1� <br /> Distance to nearest: Well ------- Foundation ,%�--------1----- Property Line --- --_._.. <br /> SEEPAGE PIT [ ) Depth ---- ----------- --- Diameter- ---------------- Number _----_---------.------- Rock Filled Yes ❑ No i❑ <br /> # Water Table Depth ------------------------------ ------- ........Rock Size ------ -------------------- <br /> V <br /> 4 <br /> 1r .Distance to nearest: Well ------------------------- ----------Foundation -------------------- Prop. Line -------------_------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------ ---- Date ---------------------------------- <br /> it s I <br /> 14 Septic Tank.(Specify,Requirements) ------------------------------------•-------------------------------------------------------------- -•----- <br /> . ' ----- - ----------------------- <br /> Disposal <br /> ------- <br /> Dis osal Field (Spe* ments) ------� g --A-� -- l rfY Re u�re <br /> , <br /> r -. <br /> R s f <br /> Ji .01V <br /> 1A <br /> --M-� �j ---------------------- <br /> ti- <br /> w e5cis n and reed addlt�on o `nrreverse side] <br /> Ti?ra ' <br /> I hereby certit. <br /> fy 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 Disfrict. Home owner or licen- <br /> sed agents signature certifies the following: <br /> 'I certify that in the performon�e of the work for which this permit is issued, I shall not employ,;any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> 1 ----------------------------------- <br /> By <br /> - Owner <br /> Signed - _ i <br /> - ------------------------------- - <br /> BY - --- ----- .Title ----- ' <br /> ---------------------------------- <br /> [If er#hari`own r} <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --U-J- - - ---- --------------------- --------------------- --------------------------------- DATE ---- /-- -21------------------ <br /> BUILDING PERMIT ISSUED ------------1--------------- -----DATE ------------------------------------------- <br /> --------------------------------------------------------------=--------- <br /> ADDITIONAL COMMENTS -------------(-----------------------_--_-- <br /> ----------------------------------------------------------------------------------------=--------------------------- <br /> - i <br /> ----------------------------------------------------- ---------- ----------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------- -- -- ---------- -------------------------------------------------------------------------------------------------------------------------_------- <br /> FinalInspection by: ------- :- --- -- - --------------------------------•------ --------------------------------Date ------- <br /> J <br /> OAQUIN <br /> ----JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />