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--- <br /> =APPUCATION FOR SANITATION PFS°' 0 <br /> .............. . . Permit No. .79 .S� <br /> (Complete In Triplicate) <br /> C,7 <br /> This Permit Expires 1 Year From Date issued 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 applicationiade- In o'mrpliance with County Ordinance No. 549 and existing Rules and Regulations, <br /> _040i JOB ADDRESS/LOCATION _:=:."�'`"`-'M�( ........ QA0. ...............CENSUS TRACT .......................... <br /> Q335 <br /> Owner's Name ...QHi�.t....�RERZ'�.E.��......�4N�t.!`a.�4f,)---...------••---.., ...:.....................Phone �.�.....-•-•----•----....... <br /> Address ..........1,Q.....5.Q.X-..._95, •--- City ....... 4E�-').t l Tl . ............ <br /> '. Contractor's Name ................. -------.license # ...._..._;._..-- ------- Phone .....•---------------•--......^C <br /> Installation will serve: Residence®Apartment House❑ Commercial❑Trailer Court 0 (A <br /> Motel ❑Other ---------•---•------------------- ---------- <br /> Number of living units:_._.!------ Number of bedrooms ...._¢---Garbage Grinder ..Yj�s... Lot Size _•- ............. < <br /> L <br /> Water Supply: Public System and name ... Iw p.......1s,1-4ME.?........JA _.U..-.......................................Privteto � (: <br /> Character of soil to a depth of 3 feet: .Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 7 <br /> Hardpan Adobe 0 Fill Material ............ If yes,type ............... ............ <br /> L (Plot plan, shawing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer i available within 200 feet,) <br /> LPACKAGE TREATMENT. SEPTIC TANK� Size..-.--__ � <br /> Liquid Depth __._ _--.� <br /> �° <br /> No. Compartments ................Capacity f Material <br /> Distance to nearest: Well ...........5- •- -------• -- �� Prop. Line .� ... ..... <br /> � _ Foundation .... fi <br /> LEACHING LINE No. of Lines ----------- __. - Length of each line....... <br /> .....!........... Total Lengtha2,1 .......... <br /> 'D' Box .-•--_- .._ Type Filter Material L.i1_:4Y.^0n Depth Filter Material ............ ............. <br /> Distance to nearest: WeII'°_._..�dU._. ..__ Foundation ....--��__:- Property <br /> Line ...�. ...••...•.• <br /> SEEPAGE PIT t)r Depth .....a ....... Diameter ._ ...... Number -------------- ...... Rock Filled Yes (ff No ❑ <br /> ter Table. Depth •---•...------•. ---...------Rock Size ...../=_2 '......•. <br /> ' <br /> / <br /> Distance / <br /> a <br /> tprtce to nearest: Well -----•-----f��.d__.`�_-•---..._....Foundation ------��.-�-._.. Prop. line ...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit -•----. ..._... Date ----------------------•--•----•---) <br /> Septic Tank (Specify Requirements) . .E.................................................... <br /> Disposal Field (Specify Requirements) ---_------_-------_---_- --------------------------------------- ............. .......................................... <br /> --------------------------••----•-•----------------------•------•--------•-. -........__.._.-.-----------------------------..-.-.....--------:--:------------------• --------------------- <br /> (Draw existing and required addition on reverse side) <br /> LI hereby certify that I have;prepared this application and that the work wiU 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 bec a subject to Workman's Co ensa 'on.laws of California." <br /> Signed .._. -------•-— Owner <br /> BY --------------------------••--•------------------•------------------------------- ----- Title ...................:......._._ . <br /> (If other than owner) <br /> F R EPA MRNT S ONLY <br /> APPLICATION ACCEPTED BY - ✓L`�"', �� °� DATE ---... �. <br /> BUILDING PERMIT ISSUED ....... ........• -- -•- - - DATE ..................... <br /> ADDITIONALCOMMENTS -------------------•--------- ------------- ---------- ---------­---- ------------- ------.................:....................... <br /> t - .... :.... <br /> ----- <br /> ----------------- ...... -- ... ...... --.._L .......... <br /> ...... <br /> --:---- Rate ..r - .......__._. <br /> Final Inspection bi N JOAQUL <br /> EH 13 2 1-68 Y• N LOCAL HEALTH DISTRICT 8/7h 3M <br />