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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> x � <br /> �'" Permit No. 7 <br />.................... _....._.... ................. (Complete in Triplicate) <br /> •• ......_•__ This Permit Expires 1 Year Fro"r� Date Issued <br /> 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 m e in compliance with County Ordinangg� No. 549 and existing Rules and Regulations: <br /> 1.� C,DR� �J ► + `- tl: �+Ji�... ?../�/C NSUS�TRACTN .W4,............ <br /> JOB ADDRESS/LOCATION - -- <br /> Owner's Name .............................. ...... .................Phone $ S:.S .......... <br /> -____. <br /> Address ....... �_:Q__.� o ...... ._._.........................•--••--•-------........ City ����'Y• .. <br /> ass. ..:_ License #crr_ . _. .. ._ Phone ...-- <br /> Contractor's Name .. -. ..t A.:---• `°g....:.............. . ......, <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ <br /> M:. <br /> Motel [3 Other _.. <br /> Number of living units:_._....... Number of bedrooms __� Garbage Griider -___..___._. Lot Size ...���� ----•- <br /> Water Supply: Public System and name ........................... . -' �l`p•- --= - Private ❑ <br /> 1 --......- <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ -Clay ❑ ' Peat Sandy loam 0 Clay Loam , <br /> Hardpan ❑ Adobe❑'Fill Material ...__....._ I#yes,type ....-----------.•-•--------- <br /> a <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; p se p ge pit permitted if public sewer is available wi hin 240 feet, <br /> --.. <br /> } Six®_' ." ?.. ....SC._!c?.:-.Q Lf uid Depth ..�1�^ ...Z ....._ <br /> {No se tic tan or, <br /> PACKAGE TREATMENT ( ] SEPTIC TAN ,Q .,.. 1i , <br /> Capacity _��n -" Type ..\_'a?. Material.__ No. Comportments ...... ............... <br /> I �..:i 1 fi -- ` <br /> r � <br /> Distance to nearest' Well ,fro.....................•-Foundation ...'_—--__.Aen, ..._.- Prop. line ..J......_._._.... <br /> LEACHING LINE [yQ No. of Lines .... Length of each line......... Tota! length ....__.. ..C�............. <br /> - 14,3 'D' Sox ...I--_- Typg Fil-.ter Material -�u� .. <br /> ---Depth Filter Material ._. 8. .... .....................•_._ <br /> r <br /> Prope <br /> � •- <br /> "`` _ .fi <br /> Distance to nearest: foundation _ Line .. ---- <br /> - <br /> SEEPAGE PIT [r) Depth ; D et - ------. N mber . ..__..� ?�.-. . Rock Fed Yes [] No.C1 <br /> RdckSWater Table Depth,. - ---••------ <br /> .. <br /> --Foundation ............. ._ Pro . - <br /> Distance t`o'�rgearest• �IVeI! ----- p• Line ..---------- ._.----- <br /> REPAIR/ADDITION{Pr v. Sanitation Permit�# <br /> Date --•............................... <br /> A y <br /> Septic Tank ISpecif i Regoir7e ents) ... ...............-........................................................................................... <br /> : <br /> Disposal Field (SP ecify"R q uirements)I --------------- ----- --------• ....................................................................................... <br /> ................................................. .............................. ....--------. ....... <br /> g' <br /> •- ----- <br /> .... .... <br /> ---------------------­------------------------ <br /> I_ (Draw existing and required addition on reverse side) <br /> 1 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 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 19 We man's Compensation laws of California." <br /> Signed.... <br /> . .............:.......... . Owner <br /> BY <br /> ---_.._. Jitie . r --------------- ----- <br /> (if other`than owner) o <br /> FOR DEPARTME USE LY <br /> APPLICATION ACCEPTED BY ......_._.. <br /> ................... <br /> . ...... ......... .... DATE .._._�J �,f� • ............. . <br /> BUILDING PERMIT ISSUED --........ •. ---- • •--• --------.... DATE ....... ....... ........ . <br /> ADDITIONALCOMMENTS ..................................... ----••--------.._..-----...--------_.....-....--•-------.........---........... <br /> ......................... .....................•-•... •..•--. -•--------....... _.._.----_... _ .._-----• -----_....:--- ....._._.._.....------.._._ .--------- --.---: -----• <br /> ..... --------•- <br /> _.------ •------ <br /> Final Inspection by: 1 ........:........•---- .....Date -----e� ::�y...---...---.._........ <br /> SAN 'JOAQUIN LOCAL HEALTH TRICT <br /> .; 13 2 , <br />