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APPLICATION FOR SANITATION PERMIT <br /> (Complete In Triplicate) Permit No. ... .. .... <br /> . ....................................................... This Permit Expires 1 Year From Oaf*Issued <br /> Date Issued <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 coonce with County Ordincincat No. 549 and existing Rules and Regulations: <br /> muR.21 p6o -- .Y ystlt-6 SOOTH oFF <br /> JOB ADDRESS/LOCATION ................_k}t k- (..!! z b.-.v l O.N...:�t.GzttT. ..... 5;#VJ9 ... .CENSUS TRACT ......... ................ <br /> Owner's Name P►LtLL. Q_*A.L-1>_------F/°kl2 tCYI 5..........LALC..:............... .I............ .....Phone . <br /> Address '7> _.. . .. - ..hF.W..'L_ -- _-. ... .................. Ciy ........ ...S ..-._.-.......-..........: <br /> Contractor's Name ..... !2-T.1. -f.t .17...--.--•s- CZ ....license # ._2_5.:1.(.:7.3Ph ..'f,��.: <br /> Installation will serve: Residence Apartment House Commercial QTraller Cosh C] <br /> Cn- �b� ! r I l r <br /> Number of living units:.. Number <br /> Motel <br /> beOther <br /> ooms . -.-Gar ge Grinder .,, .. Lof Sl/. ....... . <br /> Water Supply: Public System and name ..........- i ` <br /> Hardprdt Adobe FfIlMaterial ..... ...........................................p� Pfivote <br /> Character of soil to a depth of 3 fent: Sand L] Silt❑ .Clay- 0 Peat❑ Sa*y Loam ❑ Clay Loam <br /> O O . 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 TREATMENT1 <br /> [ ] SEPTICTANK�xf Size..... .-..X 1C_.9................. Liquid Depth ...SF....x............. <br /> Capacity .t.ZV vN1 r-L,Type .................... Moterial..Cl»is:TZA.K'f No. Compartments .....:7. .......3 <br /> Distance to nearest: Well ........10.0....................Foundation .....I..i?.'.......... Prop. Line ......J............... <br /> LEACHING LINE f/I No. of Lines ' 1 <br /> Length of each line........_`I-Cl.-...------ Total Length ....... ,G..............y <br /> 'D' Box ..... Type Filter Material L ...0:6r.4bepth Filter Materia[ ....... . .................. -- <br /> Distance to nearest: Well .....-).b.V.:.-...... Foundation <br /> ......LO.'........ Property Line .......S.............. <br /> SEEPAGE PIT Depth --.2 -'-..._. Diameter ... Number ..........(................ Rock Filled Yes I$ No ❑ <br /> Water Table Depth ....... .......SSC?............................Rock Size ......lf...AM— F!t <br /> _ Distance to nearest: Well ---------1.S-P.....................Foundation ...../-.0.!....... Prop. Line ... ._........... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) <br /> SepticTank (Specify Requirements) .._........................... ....... ......................•- •-•-----...•--.._......_....-__.........._........_................ <br /> DisposalField (Specify Requirements) ---------- .................................................. -------------------------- ---------------------------------- ." <br /> _.._.--..__... -----------------------_....------------------------I.,........---............. ._----------.--.. ... ....... -. -..... .- . ..............................- <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 <br /> eelsubject to Workman's Compensation laws of California." <br /> Signed -_.._tL�t.�_. . T)._Xt. ----. .L"W- ......................-----.. Owner <br /> By _. . .. LS�FrIt`--`-^ - ----�� _--..... .......... Title -.-._ _...._..._. <br /> [If other than owner) <br /> DEPARTMENT USE ONLY Q ry <br /> APPLICATION ACCEPTED BY .. ��.. DATE ! P-:.7 .... ... . <br /> BUILDING PERMIT ISSUED <br /> ADDITIONAL COMMENTS .. . ... . ....... . .... - . . . . I..................... <br /> DATE <br /> ..........._..._..... ....... .. ....--.. ........ ........._... ..............V_­­........ - ... . ...... ._.... ------.------...--- --- ---- <br /> -- .. <br /> Final Inspection by: ----- _.Date <br /> 13}i 13 24 1-68 lieu. c44 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />