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FOR OFFICE USE: <br /> _... <br /> APPLICATION FOR SANITATION PEP VT ,�1S— ;� <br /> .. -- - - -- ---- (Complete in Triplicate) <br /> ,1 Permit o. ..........�...---.. <br /> ............. This Permit Expires 1 Year From Date Issued Date Issued 7.5 <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 Cov tyOrdina No. 5/I49 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIONId.7D Y_.. ', Low. lJCj I 0/t /\,SNfflt_ ,.. .CENSUS TRACT ..._. <br /> Owner's Name JV14N _-C—RC -. AM.._ �....... - _ . . .. ... ... .. .. — ....Phone d 77 07.� <br /> Address 3o 7o 1�. ILoN . y <br /> iL <br /> -I �C_._:la . ... .. . ............ City 0A /<-dAIE- _ _. ..... .. .... .. .. <br /> Contractor's Name ....0 F.__..A)1_2'.o.t......... _.......... '- --- -- ----...License # ...... ................. Phone .......,...... ............ <br /> ... <br /> Installation will serve: Residence($Apartment House❑ Commercial ❑Troller Court O <br /> Motel ❑Other . --- ..... -----------_--------_-----_ <br /> Number of living units: Number of bedrooms _t2_...-.Garbage Grinder ..... ...... Lot Size <br /> Water Supply: Public System and name ---------------------------------.1.1---------1......­..................................................Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay, ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ <br /> Hardpan M 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK t ] Size........................................ Liquid Depth .......................... Q <br /> Capacity .......... ---- Type ------------------- Material---------- --------- No. Compartments ...................... <br /> Distance to nearest: Well ....................................Foundation ---------------- Prop. Line ...................... s <br /> LEACHING LINE No. of Lines Length of each line___..................... Total Length ............................ <br /> 'D' Box ._-.-----. Type Filter Material --------------------Depth Filter Material ..-......................................... (T <br /> Distance to nearest: Well ------------------ ----- Foundation ._- .- ...-.......... Property Line ........................ <br /> SEEPAGE PIT O Depth ---------- Diameter ---------------- Number ...._... ...._..... ..._ Rock Filled Yes ❑ No <br /> Water Table Depth -. ..-..._._..................Rock Size _............ <br /> Distance to nearest: Well ._.....................................Foundation ..........._....... Prop. Line ...................... <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ---.----..-__.-. ... ....... _ _ <br /> G/--..... Date -...._...... -----_- --------I ��x �y r � <br /> x�. .. <br /> Septic Tank (Specify Requirements) - -. ... - - -S..................'--------- --/--------------- ---------------------I—,...... ............... <br /> Disposal Field (Specify Requirements) _!t? ---_ -_.. he.. .J� <br /> - ---------------- -- ---------------------- ...... - - ..... ..... ----_-------------------- <br /> ----- <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 rliIrk for which this permit is issued, I shall not employ any person in such manner <br /> as to be su lett to or 3'Co nsafion laws of California." <br /> Signed _ - .. ..------- - . . -._----------.-------- Owner <br /> By . - .. ..... _.. ... -.-- Title <br /> (If oche an owner) 6�- 968 <br /> FOR DEPARTMENT USE ONLY ��riNP> �2rw r <br /> APPLICATION ACCEPTED BY.._- .- _ -i.-.- .- .. ......_.- <br /> DATE �� /.. . _... ........ <br /> BUILDING PERMIT ISSUED ---------- - - ... ---_..DATE . ............................ <br /> ADDITIONAL COMMENTS - - . :. -- - ......... ......_ <br /> -. <br /> Final Inspection by --.---- .-_ _ --. . - _. ..-.-. _.... .-Date -.---- <br /> EH 13 2h 1-68 itev. 524 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M <br />