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FOR OFFICE USE: <br /> APPLICATION:FOR SANITATION PERMIT +, <br /> = ------- <br /> (Complete in Triplicate) , Permit No: . <br /> --------------- This Permit Expires 1 Year From Date Issued " Date Issued z-/4f._�_ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to7construct 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 -----.----__1- __ 7-0-7------ ----- LCL✓--- - 1�-•------------- CENSUS TRACE <br /> -1. <br /> Owner's Name <br /> - - - -- - Phone._ 3- Z: p-- <br /> _ -- <br /> Address --- �l �� L A �r :�0 4P--------------- City T� l7CJN �� } r -----•- <br /> Contractor's Name --- - ----- --- - -- - - _ -- - -- ense <br /> Q --- ----- 0 ---------:--------- Phone --- ------ <br /> Installation will serve: ~ 'Res dente ❑ Apartment.House❑ Commercial :❑Trailer Court ;❑ <br /> Motel`❑Other ---------------------------A--- <br /> Number of living units--------- _-- Number of bedrooms _------_-_t.Garbage Grinder ------------ Lot Size ._____--------------- <br /> Water Supply: Public System and name ...................... . -_ ---- .___.Private ❑ <br /> ----- --------------------�-•-------------- <br /> _-- <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,❑ - . <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type----------------------------- <br /> (Plot <br /> _-.__...----____.._ _ __(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be laced on reverse side.) <br /> NEW INSTALLATION: g p <br /> {No septic or seepage pit permitfed if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT � _QQg <br /> { ] SEPTIC TAMC� Size---- r/ a-� -------- Liquid Depth ------//---------------- <br /> Capacity . 6J �,TYPe4� h�n.� Material______________________ No. C�pmpartments <br /> Distance to nearest•, Well ._SD_�__________________Foundation _.._.��___._...__ Prop. Line_. <br /> q , <br /> LEACHING LINE -.No. of Lines:-----2--------------- -Length of each line------/.�-------------- Total Length .4?Q__17 <br /> 'D' Box ___ J---- Type Filter Material J�Cepth- Filter Material _____________________________ --------- <br /> Distance <br /> __ __•- <br /> Distance to ne est: Well S 'Foundation .V0---_--_.---._.. Property Line ____�`_------------------ <br /> SEEPAGE <br /> —_--�_. -_-•_ <br /> SEEPAGE PIT Depth .-_ .-... Diameter 2 <br /> Number --------------- Rock Filled Yes No 0] <br /> Water Table Depth -_--� ----------- 7Rock Size -------------------------------- <br /> w <br /> Distance to nearest: Wet -..... ________________Foundation __&7---------- Prop. Line ..._ : . _ <br /> REPAIR/ADDITION(Prev. Sanitation!Permit# ----------------- ---------J----------- Date ----------_____---_-- --_----___-•} � <br /> Septic Tank (Specify Requirements) -------------------------------- <br /> ------------------------------s I <br /> _ ' --------------- ------------------------------------­------ <br /> Disposal <br /> -----------------,------------- <br /> Disposal Field (Specify Requirements) ............... . fes'= <br /> - ---------------- <br /> - ----------------------------- - <br /> - --------------------------------------------- <br /> --------------------- <br /> ------------------------------ - <br /> - --------------------------- <br /> ------------------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------------------- <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 o°fothe-San"4Joaquin Local Health District. Nome owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which tliisjpermit is-issued, I shall not employ any person in such manner <br /> as to bec e u )ect ter—workman's nsatior laws of California," <br /> Signed_ -`' - - -- -- -1- ^� , Owl <br /> =- r <br /> - --- - _ <br /> _ ner - <br /> By ------ ----- ----------- -- ------ --------------------------------------------------------------- Title <br /> ------------------ ------------------------------------ --- <br /> (if of er than owner) <br /> FOR .D PART ENT USE ONLY 4 <br /> APPLICATION ACCEPTED BY ----1 -is-- ----- ------ - - _ p �Ja qQlr <br /> --- --- ---------. DATE -----=-J��� -------- ------ <br /> � <br /> BUILDING PERMIT ISSUED ---- ------------ ------DATE -------------- - <br /> ADDITIONAL COMMENTS - <br /> --------------------------- - - <br /> -- ---------------- - <br /> z� /�A941(r_e�r--P/.S__ ---- --�4,n_R_0Q-M ------- --------- = <br /> - <br /> -------- - - <br /> - <br /> Final Inspection by: -fid- yam ✓ ------ --------------------------------- - Date <br /> - � � i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9— ' 1-'68 Rev. 5M, <br />