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POR OFFICE USE, APPLICATION FOR SANITATION PERMIT <br /> •-.._.__.__ ____._._• Permit No. T :1t <br /> _.................. 3 <br /> fCemplNe in Triplicate) <br /> Date Issued �/:.'�_7-.�.. <br /> _-_ .--...r_.. - _.---_-___--_,,,-. This Perini/GxPires 1 Year From Dare laved <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 compliiaan'ce with County <br /> 2Ordinance <br /> ,No. <br /> .554�9�and <br /> �existing Rules and Regulations: � <br /> JOB ADDRESS/LOCATION�r4l.L*___1.f .Y/2'lS..-_�..�.+.. 0..�.Grx-1.G L-!e!./--CENSUS TRACT ..aIY,7......... <br /> �_- <br /> Owner's Name ..SP#/.LLS.CQLr.-.-.�_E/W�1.Lp....s...-___---- ._..-_^..—.----------Phone .........-_.--.----•-- <br /> Address _ 1.-�i.XC_ -- ./cCc....GCXE/16R1 IJL#� --�_. City —44:d f ........49- 2-4.(.c. / .......:.... <br /> e -- ._. <br /> Contractor's NamLL,C�/1�...F 1Ch. .------------....--:---.....License#L9P.—Ar ��. • Phone <br /> Installation will serve: Residence rime House Commercial ❑Trailer Court. ❑ <br /> // Motel ❑Other . .._........_ ---................. <br /> Number of living unNs:.....1..... Number of bedrooms _,3_-...Garbage Grinder ............ Lot Sias .—......... <br /> _ ..- <br /> Water Supply: Public System and name ____._ ...»__._..___-__.... .TeS ..__._._._-______-.....___._........_. <br /> Co <br /> Character of soli to a depth of 3 feet: Sand❑ Silt❑ eat❑ Sandy Loam 0 day Loam ❑ _ <br /> Hardpan �obe ❑ Fill Material ----------- If yes,type------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, oft. must be placed on reverse side.1 <br /> NEW INSTALLATION: (No septic tank or seepage pit-per rmtted Irp*fc.sewer is available within 200 feet,) <br /> K <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-.....�2_QQ_ .-eL�___._.-_ . Liquid Depth ._S�_..------- <br /> Capacity l p01JCfype _ ................. MgterkJ-. ,t�AM1No.. Compartments _2__._,..�. <br /> Distance to nearestT Well "0................Foundation .�Q_--......... Prop. Line --.3.Q.._. <br /> ^2 Total <br /> LEACHING LINE [ ] No. of Lines -----a--...-_..--- Length of line_.. e�7L.Q-.....-.-. - Length .12 <br /> w <br /> 'D' Box _f...... Type FilterMafariair- .Z_QGr+�epfh Filter Material _...(. ..-.....:_-__._-___.+....__. <br /> r�st:Distance to ttsaWell _19W........ F•otmdation ._--------Property Line .1..Q.-_...... <br /> SEEPAGE PIT [ ) Depth .. ___-- D'ramsWr 3 wT_-_-- Number Mock Filled Yes g .rNo Q <br /> Water Table Depth --------.�.-_ e ��_ : ._.Rock Size <br /> — — �j _. �w•.._.-. Ot <br /> el <br /> Distance to nearest: Well ---_._ Q4!_.------_Foundation - ef'Q..__. Prop. urm -21..-.......___ _ <br /> REPAIR/ADDIT10N(Prev. Sanitation Permit# ..............._..............---..--_ Deft ..............-_......__ <br /> Septic Tank ISpecify Requirements) -------------..---------—•------•----•-__..___-»-___.._..-_.. _-.»a..,—___.__.._,__..____---__-_- --.. <br /> Disposal Field (Specify <br /> _........................................-................— ....___.—...._..___.__------'.__._____-_--..-----_... <br /> ............_...._...................------------------ ------.__.................................-----.-------.._--------.._.................... <br /> ------.__—__.-.__._—.__-_—..- _ <br /> (Draw existing and required•biddttion 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 Laced Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "1 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 subject to Workman's Compensation laws of California." <br /> Signed ._......... .. ...............-...._. ... ...-_-----�-_ -.-._ Owner A •�— <br /> IF <br /> By . .-�jer/. - -. ._.. . Title __..----GrIG.L..-�!"-_ _ ._..._. <br /> (If r than own <br /> 71. 0, <br /> USE ONLY <br /> APPLICATION ACCEPTED BY.-. - -... . - - - ----------- ........_---------..................... .. DATE _.—...... <br /> BUILDING PERMIT ISSUED . __...............-........ .- '-+---- ..._ _------------.. _...... ....-....------DATE_.—_.—_......................... <br /> ADDITIONALCOMMENTS_.._...-•--.—.-----..___»____1-•_......_.. _____.-_----..--'--_._—._____—_�..._. <br /> ............ ------------ „ ..--....4 _..'sero-r--s�-: : : : .T s3!r:Ta' ...:..... <br /> ..•-----..:::::---- ..:.................::_:.:.:: <br /> .. ............- --- -. ----------final Ins Dafefj=l...... :. ::::::::»_µ: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. SM <br />