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• FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> . . <br /> (Complete in Triplicate) Permit No. ._1__Z..,..3. -.. <br /> ­----- ----••-•- �------------------ - -- ---- This Permit Expires 1 Year From pate 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .---11�r.� -�--- --- ----- - -{�-R�------.LSI _ .......CENSUS TRACT __ - --J✓-----•-• <br /> Owner's Name -------- -------8.00. .._..- {�. ...'. -'� Phone <br /> --------_--- -- -- <br /> M 1 <br /> Address �_ .--�__. ..._ _., _ <br /> Contractor's Name ___-_ /� <br /> - --------- <br /> - ----_ City _ _�!/m-l�1�_�Ct`9_r•- ----- <br /> installation will serve: R ence Apa -•------------- !---•- - . .-.License # ...__._.._.....__.,_ ...Phone ..._...______._. <br /> - <br /> rtment House,Q Commercial:❑Trailer Court ❑4 I <br /> Motel ❑Other . <br /> Number of bedrooms _�......Garbage Grinder IVD.. . Lot Size <br /> Number of living units.-----/----- <br /> Water Supply: Public System and name ---------------___!. _____._______-._-.Private [s}� <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay. ❑ Peat❑ Sandy Loam e_.-Clay Loam ❑ <br /> Hardpan _..�„_r <br /> ❑ _.r Adobe ❑ Fill Materia D-- 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 seepa pit permitted�if/public sewer <br /> is available within 200 feet,) &PACKAGE TREATMENT [ SEPTIC TANK Size-•1..:�0 ---X-577... Liquid Depth _..._� ("t <br /> Capacity _ _... Q_Q Type _:f _F1 B Material.��CR�No. Compartments <br /> p i ...9 <br /> Distance to nearest: Well __.._ ._-- ._ ...__Foundation .... Prop.Prop. Line __ ._._ ..____ <br /> —'^ r <br /> LEACHING LINE , / No. of Lines _ <br /> XJ � ---�. .�_�...__ Length of:�each line _.._ __�_�________________ Total Length ..._,��Q �• <br /> t D' Box _�;j. Type.:Filter Material Ra_C..k_-Depth, Filter Material _.•.__.. . <br /> Distance to n arest-. Well --- Foundation �Q :_ Property Line _----------- <br /> SEEPAGE <br /> __-._____ ._SEEPAGE PIT [ ] De .....__. Diameter -------------t._ Number <br /> it Rock Filled L ❑ No ❑ <br /> f P -•------Rock Size <br /> Water Table Depth .-.!..'..-. f fir^i <br /> . -..+ .- _ , - <br /> Distance to nearest: Well .._- i --------------- <br /> Foundation _ .................. Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..........-_ _--- ._------------------------ Date .-_...- ...___________-_._-_•_) <br /> Septic Tank {Specify Requirementsl .._._.... ..'.' .;-_ <br /> ,`(Specify Requirem <br /> Disposal Fieldents) -- X._ISTi ,pil/ �L( [:-__-_--7E�--__ =IVM!`f4_ <br /> ..-----BE� -,b 15�mio <br /> Ci . <br /> •-- !----- -= <br /> ;_ ...._... ----------- - ..._.. _.----------- _ ..... ---- •. � <br /> } (Draw existing and required;addition on reverse side) <br /> 1 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: i f <br /> "1 certify that, in the performance of the work-for which this permit is issued,,) shall not employ any person in such manner <br /> its to becomye <br /> subject fo�W rk nan's Co pensation laws of California." <br /> Signed - ----------------------- -------------- Owner <br /> BY _------------ .. -.... ------------ --------------- ----------- ------- _-------- ._ Title ------- - ............................. <br /> (If other than owner) _ <br /> f FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY Y/•-- � .` +--_--•--- DATE ._.. ------ <br /> BUILDING PERMIT ISSUED ------ -----_--•-•-- ••------•- - - •------- ------DATE .......... -- <br /> ADDITIONAL COMMENTS --- --------_-_- - :. <br /> ............ .. ....._-------------------------- ----------- --- ----- <br /> ---•••--- -- -------- -------------------- -........__----•------------- ........ -- <br /> ------ ------ <br /> ---------------- <br /> - - - -- ------ -•-•-- . _... - - _ :. _ ----------------­---- <br /> ---- <br /> Final Inspectro ` <br /> ----------- -------------ate \ I. .. :.. �..! <br /> SAN JOAQUIN- LOCAL HEALTH -DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />