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FOR OFFICE USE: <br /> 1 My ` . APPLICATION FOR SANITATION PERMIT <br /> ........a_'.,_- :'. s Permit No. .�d_j , <br /> (Complete in Triplicate) ... <br /> _............- - ......... Date Issued <br /> ........................ ........................... This Permit Expires 1 Year From Date issued I <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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATTION ._- ..99..ZX2......._��,-..p._...-�fJ�e ...._,rQ -.........CENSUS TRACT --------.---•-------- <br /> Owner's Name ----W-1-- -C/Ja�....................­­------------- ..... ----.........................Phone ...-............................. <br /> Address ... .......................................... .......-----_-.....CS t.?+"' - ......_._....... <br /> *Y .. <br /> Contractors Name .......eeal74...r. iPi� ./..'....._.............::........License <br /> Installation will serve: Residence Apartment Housed Commercial.Trader Court C1 <br /> 'r Motel ❑Other-----------_................... ....... <br /> Number of living units:.... ..... Number of bedrooms ..ta_--..Garbage Grinder yp",,t. Lot Size -�+Gi�'�.�d ...._....._... <br /> Water Supply: Public System and name ---------------------.............--------.._....__..--------------------------......----------_..Private <br /> Character of soil to a depth of 3 feet: Sand O Silt[] Clay [-) Peat[] Sandy Loam o 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 be placed on reverse side.) <br /> i NEW INSTALLATION: (No septic tank or.;seepage pit permitted if public sewer is available within 200 feet,) <br /> ei / <br /> PACKAGE TREATMENT [ J SEPT/IC/TANK��!p' Size.L/_f.��!..A?........... .. Liquid Depth �j/. <br /> ' Copacitycz.,V.(�..._ T � $ <br /> Type .. _Ll ._ Materia L.SD.QNo!'Compartments ....... Q' <br /> Distance•to•neares't: Well' _ _ <br /> ._ wr,.fa=....__ ...... ..Foundation ..1�.�n ......... Prop. line .4 •_Z9A ..... <br /> LEACHING LINE _ No of Lines ---i! <br /> _._...... Length of each line....�'?40................ Total Length ...._.-__.. <br /> 3.'D' Box /.e.S.1Type Filter Material/, P.G1GDepih/Fi�'lter Material /�$f� - <br /> t Distance to nearest: Well �W.............. Foundation ...N.f..Q__.._._.... Property Line _.lam..._._..:.... <br /> SEEPAGE PIT Depth, t _�-- Diameter a' <br /> IfQ I -----_. Number ..._.� ................ Rock Filled Yes <br /> ' No <br /> Water Table Depth t_._.. ADS'! ............................Rock Size .� �:.. �.'.......1. <br /> i i <br /> Distance to nearest: Well ....._ ........ <br /> ..�Q........ Prop. Line ...p..._-....._.._. <br /> REPAIR/ADDITION(PreO Sanitation Permit**............ Date ..................................) <br /> Septic Tank (Specify Requirements) ....:...._,........•..........---•---...-----`-----...............................--- <br /> Disposal Field (Specify Requirements) ....___...........:.--......... .......................-.......---...........-.......I............. <br /> --•---•^....................... <br /> t - <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 of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performarice 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 ................C, tt`• - <br /> ..-' ---... .--- "-- -... Owner <br /> j ' <br /> BY -.-'- --- .. �.......................... Title <br /> (If of an owner{ i <br /> 3 FOR DEPA TME•f USE ONLY <br /> APPLICATION ACCEPTED BY- r,---- - --- -. .... --� ------------------ .. DATE --S_-5--1v---..... <br /> BUILDING PERMIT ISSUED ..... -------- -- - --- - .. .. .....--- •---- .. . DATE --.............. .... ................ <br /> .......•-ADDITIONAL COMMENTS - Cpl... ---------- ....... - ........ ......•------- <br /> -------- <br /> - -- <br /> z----------- -------------------------- .............................. <br /> s . <br /> V <br /> vFinal Inspection b - ........................................ - - --i.............Date .saw......�•�.C. -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.H. 9 1-'68 Rev. 5M. %7 <br />