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FOR OFFICE USE: t <br /> APPLICATION FOR SANITATION PERMIT <br /> ............................ ........... <br /> (Completa in Triplicate) Permit No. ..7. 'y.b.... <br /> .........................................................I This Permit Frpires '. Y,nr From tato Issued <br /> Date <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: + x <br /> JOB ADDRESS/LOCATION .. ............................. ..CENSUS TRACT �. �r._..... <br /> Owner's Name ...,�... .....,�?. .t<{- ---`......... ............................. ......Pho <br /> r J Y T <br /> ` Adores .. .... t+2.r-Lcl........ ..City . .... .... ... . .!ahs..-.�r:7.IL...:�`...................... <br /> Contractor's ..O.-License # ........................ Phone .!�_._.C.fx:/...,c.4. <br /> Installation will save: Residences Apartment House❑ Commercial []Trailer Court <br /> Motel ❑Other .... ....... ............................... V t <br /> "!umber of living units:....!..... Number of bedrooms -.,3.....Garbage Grinder Lot Size ....... ?�y, <br /> "e Water Supply: Public System and name ................---------------------- ..........................................Private AL <br /> Character of soil to a depth of 3 feet: Sand❑ Clay [:] Peat❑ Sandy Loam ❑ Clay Loam �K y <br /> Hardpan Adobe 0 Fi!I Material If yes,type..........::................ <br /> ' (Plot plan, showing size of lot, location of system in }"ciiant­ v,� <br /> tvells, buildings, etc. must be placed on reverse side,} N <br /> NEW INSTALLATION: [No septic tank or seepr•:. pit permitted if public sewer is available within 200 feet,j n : <br /> �+ PACKAGE TREATMENT [ ] SEPTIC TANK[� Size.... .......... Liquid Depth ._.60!............... NL ' <br /> Capacity - Type ....��-- Material rrnNC+et�No. Compartments ................... <br /> _ Ca GS'bd <br /> Distance to nearest. Well ...........Foundation .....6............. Prop, Line <br /> LEACHING LINE [ J >.Io. of Lines -......../----------- Length of each line.....�.......... Total Length _ ✓...: " <br /> �' <br /> 'D' Box ....-. ... . Type Filter Material �.!'�.N4�....Depth Filter Material- .-..�...................... ........ _ . <br /> Distance to nearest: Well ......-„5.0.0 Foundation ... .................... Property Line .1. :4..___._ <br /> t ` ; SEEPAGE PIT [ j Depth ..4.�^,�-. Di meter Number ............:........... Rock Filled Yes [?�, No 0 :r <br /> Wa,er Table Dept}`40—'40- .---"--” Rock Size <br /> Distance to nearest: Well ......-L©C�.-..-�................Foundation .._..._...........-_ Prop. Line ..................... . <br /> § + <br /> REPAIR/ADDITION(Prev. Sanitation Perrriit# .............. .._ Data ...................-------------- <br /> - <br /> .} J <br /> _y Septic Tank (Specify Rec:uirements) ........ ........... .. -_-...__...............__...... . .._ ........ r <br /> Disposal Field (Specify Requirements] .....tc?J..-.. •a:-t:=r�1%,� ....yc....1` i . <br /> v <br /> ........ .P�j.�.--.--.. .._�_........................................................................................... ti <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared thi"; application and that the work will be done In accordanes with San Joaquin ; <br /> County,Ordinances, Slate Laws, and Rules and Reg:+latlons of the San Joaquin local Health District.Home owner or Ihett- <br /> f. sed agents signature certifies the Following: <br /> ILI certify that in the performance of thew rk For which this permit is issued, I shall net employ any parson in such manner" . <br /> 6, as to become iub'ee to Workman's Ca Sutton la�vs cos' California." f' <br /> :f?i"aii, By Q <br /> Owner <br /> Si ............. le .... <br /> ...... (� ! <br /> ts:l; (If othor than owner; ., <br /> .;4 FOR DEPARTMENT USE ONLY _ .. <br /> APPLICATION ACCEPTED BY, .0..............­.. ............. ................ ................... DATE .-. ... ...� -...�.J..3.:t.: F <br /> BUILDING PkRMIT ISSUED ...--.... ......................... <br /> .: ADDITIONAL COMMENTS2 <br /> ........................................................................................................................ k <br /> ,r <br /> a <br /> ` ................ ....... . ............................ ... <br /> :. S.............:....... --. -....... ........ <br /> Final Insoec ��__ _ ........_.......---- /.".G `�, .. " <br /> s`>.. Date .... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r E. H. 9 ',• 58 Rev. 5M <br /> r "���,p...^r+d.R�cC';J+,tic:.�.+�f:,.4"it'"rC.7w�•t��Ywv'1.4�r.i,.�� "7 �•a'�'.:a'. ... ... •. __ ,.. -. .. �. c. ... � � � ^;;.F�';=fi�rr"+ <br />