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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ............... .......—..............._... 7ro C 3 <br /> .�.-�� .. .... .. . .. (Complete in Triplicate) Permit No. -•.............. <br /> . ............... This Permit Expires 1 Year From Date Issued Date Issued -;7-3,,"- <br /> Application <br /> 7-3iApplication 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 ........... ...... _--•�� _ .- .;�. �` CENSUS TRACT <br /> ----- <br /> -. ...--.._.. s..r� ------------- <br /> F r - <br /> ' Owner's Name �f !1J,......_' <br /> .................r-----.................._.............Phone .go��.-.S�.:Q---l•--- <br /> Address ; <br /> �.?�•y TJ.A. ---...5.�.... <br /> Contractor's Nome ....... ......... City ... IArYTE.c. ........... .-------- <br /> � i .......-..•---.....-- <br /> ....,Q...�,-- /=uLL. --...-... <br /> License # 07..5`5. ... Phone r� ✓ '.l<.S! _._._ <br /> *'Installation will serve: Residence W Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other ------- <br /> Number of living units:-. -.1_...,- Number of bedrooms _-.3_ ___Garbage Grinder ........._ . Lot Size / <br /> Water Supply: Public System and name <br /> ......... <br /> ......................................... .....-P ivate <br /> Character of soil to a depth of 3 feet: Sand' Silt Clay <br /> J ❑ ❑ y ]w7❑, ./+.,Peat❑ Sandy Loam � Clay Loam❑ <br /> `0 �k[ ' <br /> -----•--.Hardpan-B---Adobe-❑�.-Fill-Mat#etial•--.T:�,1f-yes,-type_,r,�.:,,,�,... <br /> _ - ------- <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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT -- i Z/ <br /> ( ] SEPTIC TANK ........ Liquid Depth ... ..S'. .......... <br /> � � I Size._6_44 .............. <br /> fapacity /, p p. ---.. TypeRe�-�.OS.%__ Mat4riai........ .......... No. Compartments-. pi ---- ..:.......... <br /> Distance to nearest: We - • Foundation . <br /> LEACHING LINE <br /> l r th . . 1/49- ...... �rop. Linell�!.......__. 6 <br /> [ ] No. of Lines L ngof each line ....R4 ............... Total Length--- -- 6 <br /> D' Box j. Type Filter Mdferial f---Depth Filter Material <br /> distance to nearest: Well ...6`..Q-�------ .- Foundation ,0._r. I m <br /> ......-- Property Line ..6"...............:. <br /> SEEPAGE PIT [ ] Depth i +' <br /> Diameter Number - .• ....................--- Rock Filled Yes ❑ No <br /> --------- <br /> (/Mater Tobie Depth V ' <br /> I <br /> Dstance.to,nearest: Well ........ ...... <br /> Foundation Prop. Line ......._ ...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .•. ..... .... . .. F <br /> t --- .....---••----...... Date <br /> Septic Tank (Specify Requirements) ,! <br /> ------------ ------------------- ----------------.._.-.... .-........... .._........ ......... <br /> Dis osal Field (Specify Requirements) ------- .---- - fi <br /> 4P l P Y q ----...-----•- <br /> 1 ( •------------• .................... . ......,-- ....... <br /> ---' -------- <br /> - <br /> --------- --- ------ --.._.. .._--.... t_..... ....... . . ' <br /> i <br /> {brew existing sand requirecl,addi:tiorr�on reverse sideLN s <br /> I hereby certify that I have prepared this application aredyfhaTthOe'wrk' wilt be +don`ein dcio�dance with San Joaquin <br /> County Ordinances, State ;laws, and Rules and Regulations of the San boa�uiw-Lorpl�-H attl,District! Home owner or licen- <br /> sed agents signature certifies the foliow` 3 j <br /> "I certify that in the perfoemnance of the`;work for which this permit is issued, I shall not em to , <br /> as to become subject to W6 rkman's Compensation laws of California." p Y an Y'person in such manner <br /> Signed -. .---•----�c v..zGIC5-c Owner <br /> 1 <br /> BY .... ,.. ......---�. ........... ...:._.-... Tithe . .... <br /> . .-- ..... ------------- <br /> (If other than,. _.owner) -------- <br /> ....... ............. ....... ... ................ . <br /> -- -WFOR DEPARTMENT USE ONLY I , <br /> APPLICATION ACC EPTEDYe,.. .- _ 1 23l <br /> BUILDING PERMIT !SS'UED <br /> ----------------------­---- <br /> ---- --- ----- - ,:.- .. <br /> ADDITIONAL COMMENTS <br /> ..............----• ••--------- <br /> DATE --... ----..... j <br /> •-------------- ........................ --------- .... --..-- - <br /> .-- --• ----•---•----------- ---- -- <br /> ---------------------.. .............. <br /> ..------------ -------- -- -- <br /> Final Inspection by: .. ._. _ <br /> ......... ._..- -------Date F . .. . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> :.E_H. 13. 241-'68 Rev_ 5M - - <br />