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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .... .................................. <br /> (Complete in Triplicate) Permit No. ..7 :. 6._- <br /> ---------------------•........ This Permit Expires ] Year From Date Issued Date Issued .-7:: ........... <br /> Applications is hereby made to the San Joaquin Local Health District for a per 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 ..... .. Sa:.. Thelma ....CENSUS TRACT <br /> Owner's Name ............... ...Phone <br /> Address .......go2...So,....Ca ' '© ......................................................•... City ­Stkn............................................................. <br /> Contractor's Name ..B1ackard' sept�.c_..Tank License # 26x.......-._ Phone ._. b _�` a : ...... <br /> Installation will serve: Residence:]Apartment House 0 Commercial ❑�rai�err�ourt ]] <br /> Motel ❑Other ............................................ <br /> Number of living units------1.... Number of+bedrooms ..2........Garbage Grinder ....... ---- Lot Size 6.0'x1.0-Q'_....................... <br /> Water Supply: Public System and name ..........a-lty------•-----•------•-----...---•......................•---= .............................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 <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 be4loced on reverse side.) } <br /> NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer Is available within 200 feet,) f <br /> .PACKAGE TREATMENT [ ] SEPTIC TANK.1 ] Size................•___....--......_...._---_ ----- Liquid Depth ............. r <br /> Capacity --_--------------- Type ....... Material----..-----_-------- No. Compartments ._._....__ ........... V% <br /> Distance to nearest: Well ....................................Foundation .........---------.... Prop. Line ._---------_------ <br /> LEACHING <br /> --..-----.__--._ -LEACHING LINE JA No. of Lines .... .----_------------- Length of each line--------------4.01....... Total Length --.....40.1-------------- <br /> r 'D' 8z5c�-:- ::_-Ty`pe Filter M�tericil 2,� . Depth Filter Material 19................................... <br /> Distance to nearest: Well Foundation .......20'.......... Property_Une--zr20'.............. <br /> SEEPAGE PIT tt Depth ---25-!---------- Diameter ....... *__ Number .1......................... Rock Filled Yes Qj• No C <br /> Water Table Depth ...........9 I........................ __Rock Size..._.__.__'-2" <br /> t Distance to nedfest: Well _..__�._r-_ { <br /> �� -� —.- -- .Foundations.210.!_........ Prop:.Line 20.!............. <br /> REPAIR7A13IWftSN ISrev. Sanitation Permit+# I <br /> .........------------------••--------------- Date .................................. <br /> Septic Tank (Specify Requirements) .......................................................................... . -- <br /> Disposal Field (Specify Requirements) ............................................... <br /> --------------- .................... -----..._-------------------•------------------••----•-------------------..-..---------------------._...-.......-..-----------------------•-••-------•--•------ <br /> -G " .. = ' <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 of the Son Joaquin local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I 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 Workman's Compensation laws of California." <br /> Signed --- ----------------------------------------------------------------- -- . Owner <br /> a �` <br /> BY .a .......-... .,�! sr� ..� .... Title .....Con-traotai.................... ... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ... ... ................. ..................................................................._. DATE .......`.�-�... ............ <br /> BUILDING PERMIT ISSUED ...... ........ . ....�..... ..................DATE ........................................ <br /> ADDITIONALCOMMENTS ........................................................................................................................_................. <br /> .............................................. •--- - ..------------------•---- <br /> -------------------------------- ---- - - -------- <br /> ---- ---- -------- --•-• --....--••---•---•---------..------- .._..-------- ----�}} _ --- ------ <br /> FinalInspection by: •----•...................................................Date .......l.- 3 �2----•--............ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 24 1-'68 Rev. 5M 7/72 3 M <br />