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r <br /> FOP OFFICE t�,r <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. 7? <br /> (Complete in Trlplica I <br /> This Permit Expires 1 Year From Date issued <br /> Date Issued <br /> Application ,t tier': . ..,-?� .o �I,c ;in Jr,aqu'n Local Health District for a permit to construct and install the work herein <br /> descril,ed Th s o-r :n .co- ado in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> f �� r ;. �'. '�r/A�!!'�/9/11t /I CENSUS TRACT �'.... ..... <br /> 148 ADDRESS 'tOCnT�^r� � ' � � � � <br /> .. Phone .. .. . ... . <br /> Owner's Nar.,,.�� <br /> .. ... . , <br /> b <br /> Address A' - .�.. .... ..--...-.City .0 �� !;.,, . <br /> Contractor's Name license �� �g Y Phone <br /> lnstollution will servo- P-s`d-t4ce Apartment House❑ Commercial []Trailer Court ❑ <br /> Motel ❑Other ... .. ............... .......... <br /> Number of h,-ng units: Number of bedrooms ..!!�....-Garbage Grinder Lot Size <br /> .--.- <br /> Water Supply. Pubic Svstem and name - .................................................Private <br /> Character of sol'. '^. c pr,h or 3 feet. 5-1cd ^ Silt❑ Clay rJ' Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ( Adobe 0 Fill Material If yes,type . . . . .... .... .. . . <br /> (Plot plan, showing sire of lot, Iccation of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION- INo sceptic tank or seepage pit permitted if.public sewer is available within 200 feet, <br /> PACKAGE TREATMENT { 1 SEPTIC TAMC Size -..�...�-�.���. �..--. Liquid Depth ..._`�................. <br /> Cc�Ra6ty/cPCC !�,..� Type �l�u.t�.ar.... Material..Q�^�t.—No. Compartments ......-.�1-.. ' <br /> 1 Distance to nec est: Well . .. .....���_.. ............Foundation �0.�..-...-- Prop. Line -.-.. ..�........ <br /> LEACHING LINE fl! No. of Lines 2 _ . Length of each line.... .../0.D...`.. .. Total Length <br /> s 'D' Box I Type Filter Material -.... ..6.. ...Depth Filter Material ... ....�.�[ ............................ <br /> Distanr-e to nearest: Well .........SQ........... Foundatirn !.�. .... ..... Property line ....... --•--.-.-. <br /> { SEEPAGE PIT r►; Depth S Diameter ..-33."Number rL� Rock Filled Yes No <br /> ( %Vot^r Table Depth ..............i:ock <br /> io nearest: Well f41x'..1....- ......s`. ..... Prop. Line ...: .............. <br /> w <br /> i REPAIR/ADDITION iPrrv, San totion Permit -... <br /> • � _.. .. ..... . .... _ Date ..........) <br /> fSeptic Tank iS Pr �n,�nts ... ......... ............_...------- .....-\ <br /> t Disposal Ficldr :riot !V I Fequirr,mentsl -- .................. ...................................................... f <br /> ........,....,. .......... ... .. ................... .................... ....---- ..............................� <br /> IDrow existing and required addition on reverse side! } <br /> 1 hereby certify that 1 have prwpnrW this application and that the work will be done in accordance with San Joaquin ' <br /> County Ordinances, Stnte Laws, and Rules and Regulations of the San Joaquin Local Health District. Home Owner or liven- <br /> sod agents signature certifies the following: <br /> "I certify that In the performance of the worlr for which this permit is Issued, I shall not employ any person in such mannet <br /> as to become subjert so Work non's Compensation laws of California." <br /> Signed _ .,.,� .....- Owner <br /> By Xitlez l <br /> (!f other rh�in owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED E.Y .. ..... ............ ................- DATE ..11.., ..-1 .Z........Y.. <br /> BUILDING PERMIT ISSUED .._ .. ........ ..................... ...................... .-DATE ., ......................... ........ <br /> .....- <br /> '.DDITIONAL COMMENTS ..................................... ...... ....................... ..................................... . . <br /> / .................... .......... ................. <br /> Final Ir•spection by at <br /> SAN JOAQu..j LOCAL HEALTH DISTRICT <br /> E. H. 9 1•'bf3 PC— SF.+ <br />