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.......... . _...- - <br /> APPLICATION FOR SANITATION PERMIT 7�-/73 <br /> (Complete in Triplicate) Permit No. ..................... <br /> ............................ ---............ . . <br /> ......_..... This Permit Expires 1 Year From Date Issued Date Issued .3...3 7k <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construd and install the work herein <br /> r described. This application wi h Count Ordinance No. 549 and existing Rules and Regulations: <br /> PP is made in c m I'a ce y - .......CENSUS TRACT <br /> JOB ADDRESS/LOCATION ..�-..._sr�......�.._....'.:.:.-...- .c..r.-�:e.-...-..ci...�-:.........L��. .,.� ...... ............... <br /> r Owner's Name � 41 <br /> . . ...l.. . . .... ... ................................ ......Pone <br /> AddressOC..O � ....... .p."y. 7------------------------City I........ ........................... <br /> Contractor's Name ....aE% C ...--. 5 ?✓t if' License # . �5..f�%b . Phone <br /> r <br /> Installation will serve: Residence❑Apartment House Commercial Praller Court ❑ <br /> Motel ❑Other....... ......................... .......... <br /> r Number of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply: Public System and name -.............-............•..... ... - ..... ._-----.._._....-.................................Private <br /> Character of soil to o depth of 3 feat: Sand J] Silt❑ Clay ❑ Peat❑ Sandy Loam x Clay Loam ❑ <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.),Q <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT <br /> 17 SEPTIC TAMC Size.. r� .X.5 4 ..iT -.� .�_..... Liquid Depth ..... ­zzi............. p( <br /> Capacity`��-Az_. Type lPie€.' 4jj-MateriaLil?C✓ .h'.l Na. Compartments ......ate........... 1 <br /> Distance to neare�/stO°. 0 a <br /> : Well .--..--ZgsI:. ......._...Foundation .... ........ Prop. Line .......s� .'........ <br /> LEACHING LINE (� No. of Lines .......7.............. Length of each line-----ejPP.� ........ Total Length ....��t .'........... <br /> D' Box . s Type Filter MateriaLt4.'�. dt</�..Depth filter Material ..........�? ...................... <br /> Distance to nearest: Well -._./.4-50.3-._... Foundation ....../,0-- ........ Properly Line ..._u-..j........... <br /> L_ SEEPAGE PIT_ ( J Depth_ ..--_.... --------_Diameter Number .......... Rock filled- Yes-U- No-Q <br /> Water Table Depth ......................... ......................Rock Size ................................ <br /> Distance to nearest: Well ....................... ...............Foundation _....... .......... Prop. Line ........._........... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I <br /> Septic Tank (Specify Requirements) _......................._.....--........... <br /> Disposal Field (Specify Requirements) ------------­-•..... ............ ----------.........----------. .......... ------------------------------------........... <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 performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become sable t Workman's Compensation I s of California." <br /> 00 <br /> Signed ... - - --- <br /> cF.. .- .... Owner <br /> 81 - - -/` Glc'+- - -------­---- --- -- ;fir ------• Tithe .. _._-......__.._.....-.. .. <br /> (If other than owner) <br /> r FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- -- -- --- ------ -- ----_- --------- ------ ------ ------------ -------- DATE .3-30er <br /> -l --......: <br /> BUILDING PERMIT ISSUED -------- . .................... -_ .................... ...---- -- ----- ----. - -------------DATE ._.._...- ..... ------ ............. <br /> ADDITIONAL COMMENTS ----- -- ----------•----- ---- <br /> ..................... ----------------- -- -------------------- ---..._..._....... <br /> --------------------------------------------------------- <br /> - ---------....... -- ----- <br /> Final Inspection by: ....------- - - - ........_..-----._..._Date 4t .. . <br /> EH <br /> .. .EH 13 21i 1-68 Rev SAN JOACAAN LOCAL HEALTH DISTRICT 8/7h 3M <br />