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-FOR OFFICE USE, <br /> �. APPLICATION FOR SANITATION PERMIT <br /> .:.......................:...................... (Complete In Triplicate) <br /> Permit No. <br /> ... ....... ... ... ............. This Permit Expires 1 Year from Date Issued U Date 1a:uad <br /> f <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin <br /> described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> r <br /> .JOB ADDRESS/LOCAT �J �?'�? r <br /> . ...._ .�. . ���-���...- - ---..:�. . ....... ..... .�-.............-.cENsus TRACT ...... .. <br /> Owner's Name ..- .. .. . 0... ................... ...... ..... <br /> . ...:...............:Phone-• la. <br /> Address .... ...... <br /> ,...:... .. City. n...t.......... :. <br /> Contractor's'Name ... _.a.. .i� ... z.=..: f�. T. ... ...........Eio911se.5P .............. ........ Phan <br /> Installation will serve: Residence; Apartment Housefl Commercial❑'hailer Court E] 114 6-5"7.. <br /> motel❑Other.........................I........ <br /> ther . <br /> Number of living units:--�-....... Number of bedrooms :.....Garbage Grinder .... Lot size . :... . .��'. ...... <br /> Water Supply: Public System and name ........... .....:........................ .............................................. <br /> Prhrdte Q I <br /> Character of soil to a depth of 3 feet: Sand 0. '.Silt 0 Gay 0 �Peat[3� Sandy boom E. pay Loarn❑ <br /> Hardpan Q' Adobep Fill Material ............If yes,type............... ....:....:.. <br /> !Plot plan, showing size of lot, location"of system in relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage it permitted if public sewer is available within 200 feet,! <br /> PACKAGE TREATMENT .I SEPTIC TANK ]c`'Xi s %�• < Size. . .. ............... . Liquid Depth ................... <br /> Co d 5.:::.. Typo CormpartrneMs ..... .. <br /> par ty �!... .. Material...:..........:....... .No. ... .... ..... <br /> Distance.to neaiest: Well ....l:� P."f; .. ......Foundation... .i ..... ..... <br /> .. Prop. tine. :. 0 <br /> (E; NG'riLINE ( ]. No. of Lines .f.:...... : Length_ol..eai �........ Total,Length ..r� q <br /> 'D' Box eYIJ:Aype lifter MsSterioV,r�-.i±..1:........Depth Filter Material ..................................... .-jj�� <br /> Distance to nearest: Well .. .`_. .. Foundation .4lo r Properfy Line .�S'Jt.�...........J <br /> _._...,_._. <br /> SEEPAGE PIT ( 1 Depth c�...r._ ... Diameter„-Ai..-_:. Number ..I...................... Rocklilled Yes :No <br /> Water Table Depth ....... _.... :. . .....Rock Sire , . . . .� <br /> Distance to nearest: Well . .,� .f............ ......Foundation ,lQ::f:� . Pro tine .... .l.....il"11« - p. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................... Date .................................... <br /> Septic Tank (specify Requirements) - }” ....... ...:.:.. ......... ......................... .......................... I <br /> Disposal Field #Specify Requirements) .:p :riC. � .�..1�1_F? - :c -;� -..:' .. . ............... <br /> -- r ......---.. .......... . ..... .....��.- .... _._.�.............. 1 ... . ... <br /> 4: , � <br /> .......... .. .. . ---..... .. <br /> :. .. .....................q,..:- •...._.:......_.__..._........ ................_.__. _....... . <br /> '!Draw existing and re uired addition on reverse side <br /> I hereby certify that I have prepared this application and that the work will be done iii accordance with Sart Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;District. Hesse owner or liter. <br /> sed agents signature certifies tate following: 1 <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 suNect toY"r n's Compensation laws of California." <br /> .. i <br /> Signed _C.By <br /> owner <br /> - <br /> ,�.. t. <br /> ��� ...__. title ... ................... . <br /> (If other than owner) <br /> ' FOR DEPARTMENT USE ONLY <br /> APPLICATION .ACCEPTED BY � .... DATE <br /> BUILDING PERMIT ISSUi'.D ..-------------- <br /> DATE ....----..-•-•-•----..:....__....... <br /> ADDITIONAL COMMENTS _�__� aj�-_ ....... <br /> .moi. •-•---- .............................................. . ..- <br /> -•.-- • . -- •-• - ---- .......... ....--••---------------------•---_ ............. _ <br /> . : <br /> -----------= -_... _ ..._... . ........................................... <br /> _..._ <br /> Final inspection ----_-_--- -_._............... .................. -._Dat <br /> z e �. ._ ................... <br /> >;Fi 13 .2h Z-•6 v.,5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />