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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No: .---��--=�-`��� <br /> -- -------------- --- ------- ------ --------- ---- (Complete in Triplicate) <br /> ------ ------------'"----------------------------------- <br /> Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> ---------- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> f;. described. This application is made in compliance with Coun#y Ordinance No. 549 and existing Rules and Regulations: <br /> -a' I <br /> �- <br /> JOB'AQDRE55/LOCATION .-1� '2� -.-- F�f NCx`-_ RK.4_. R., ----- - I- d---...CENSUS' TRACT --------------=-----=-- <br /> y <br /> lFST t Phone <br /> ne <br /> Owner's Name ------ROLU- 1LI-I.R ----------------- ---------- --- :-• ----- -- ------- <br /> ------------------------------------------ <br /> Address <br /> ----- <br /> ------------------------------ <br /> Address - - <br /> n ----- Ciry �Qp <br /> ' <br /> Contractor's Name - '�` S. 1_LR�, License # -�r�J�7s// <br /> Installation will serve: Residence 'Apartment House'❑ Commercial []Trailer Court ;El <br /> Motel ❑ Other ------- - ------------------- <br /> s <br /> t p II -a <br /> t <br /> r Number of living units:'-:_f-t_-_- Number of bedrooms J_--___-__Garbage Grinder -- Lot Size ----------------------------- <br /> k —Water Supply: Public System and nan 11-96-----<!Rj< ---WATER---- ------ ---------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'E" Silt❑ Clay .❑y Peat El Sandy Loam E] Clay Loam ;❑ <br /> Hardpan ❑.: <br /> < � z Ado'be:Q Fill Material If yes,fYP <br /> e�7 --------------- <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 /> p seeps e p t�permitted if public sewer is available within 200 feet,) 1 <br /> NEW INSTALLATION: [No septic tank or ! <br /> -PACKAGE TREATMENT { SEPTICTANK' 4 ______________ Liquid .Dept) �� <br /> - t ii�� Size=- � <br /> Ca acrt <br /> Type pE�`7�- Material__ -f _ No. Compartments :---- <br /> P _ <br /> Distance to nearest: Well ...... -� ------------Foundation ----- --`--------- Prop..Line ----±-------------- <br /> Len Length of each line g <br /> Ii c <br /> LEACHING LINE No. of Lines -----/. g ®__ __.------ Total Length _----- --_ ------- <br /> - - - --------- <br /> 'D' Boxyr�Type filter Material _Q�_ Depth Filter Material _____ _--`---• -----•----•-----•- <br /> N <br /> Foundation Pro a Line -:5_ <br /> ----------- <br /> 3 tDistance <br /> to nearest: Well �� ---� --- --------- p � ' <br /> SEEPAGE PIT [ } Depth --------------------�Diameter ---------:___-_- Number .--- _-;a=.--------------- Rock Filled Yes ❑ No I❑ <br /> -� ; - ' + <br /> Water`Table Depth�--------------------------------------, ,� - Rock Size <br /> -- ---- --- - <br /> ° Distance to nearest: Well ------- -----------------Y--------•----Foundation" Prop. Line ---•----------- <br /> - <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -•---------------------- Date -------- `--------•---------- } <br /> i <br /> Septic Tank {Specify Requirements) ------------------ ------- - <br /> Disposal Field�(Specify Requirements) --------------- - ---------- -------------------------------------------------------------------------------------- --------------- <br /> �. - <br /> k � I: t <br /> ---------------------- --------------- ------------ ------------------- <br /> .. ----------------------------- --------------------------------- - = -:: - <br /> I <br /> {Draw 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, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the4performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to beco a subject to Workman's Compensation laws f California." <br /> .c; <br /> Signe - --------- -- ---------- ---------------------O r '. .. . <br /> -- - ---------------- - -- -------- - <br /> RTitle -- ------------- ----------------- ----------- ----------------------- <br /> By ----- ---- -- t <br /> -- - ------ --f-- ------- hon--- <br /> (If other than owner) � . <br /> ._FO 'DEPARTMENT USE ONLY <br /> C <br /> APPLICATION ACCEPTED BY - t- ---------- ---- ----------- --X----------------. DATE <br /> t BUILDING PERMIT-ISSUED,'------------ ------------------- ----------------------------------"--------#------- ------------DATE—-- -------- ------ <br /> ADDITIONAL OMMENTS YR M --- - � � -- -` N4 1 T!©1V is <br /> CrA�l1 F 1-n RCI- ----- -1 N,�-S_ --------TRrjv(c,f t--------------- <br /> �lV-r-17TH y$-'------- - - 1� '=� a T3 �----------------- <br /> C�v111 Liu J- [1111[x- r cRP1 ��?'_ Imo-o_-4,A4-5__- <br /> -- ---------`--- r� <br /> GI- - - -----1� - ---=------ <br /> Find) Ins c io�i na �iorn� . . Date ------- ------------ - ------ <br /> I A Da <br /> ----------- <br /> /(\\J� - - -- -----I AL HEALTH DISTRICT J� 7— <br /> E. H. 9 1-'6$ Rev. 5M <br />