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FOR OFFICE USE: <br /> ADPLICATION FOR SANITATION PERMP7 <br /> �. swof (Complete in Triplicate) -.001 Permit No. ._. ..- .. S- <br /> _............. .... .-•----- ............ ... <br /> - Date Issued -_�z._....... <br /> This Permit Expires'1 Year From 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 V _ ._; if_ _� . • _.lF_-fC�............-............CENSUS TRACT ................. <br /> Owner's Name ..._.--------- �i -----• -- --Ct-Cr .1`._Y.---------- --.-•------Phone K— <br /> Address ._._T_` Q._� ------Y - 1.°.Cb .=..._ --------------------City ---------......._ <br /> +Contractor's Name ._.. =.fir :_ !�c �--- sem----.License # 5�3�c 3--- Phone <br /> installation will serve: Residence Apartment House C] Commercial❑TrallerCourt fl <br /> La Motel ❑Other --------------- --------- <br /> Number of living units .....j___ Number of .bedrooms _. -------Garbage Grinder ------ ----- Lot Size .../&1P_ mow_•-_-______-- <br /> Water Supply: Public System and name ------------ ----------------------------------------------------------------------------------._._Private <br /> i6-Charocter of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat El s Sandy Loam ❑ Clay Loam ❑ <br /> - flbroon ( Adbi5e ill Material :``--- If yes,type .. <br /> -------------- ---------- <br /> o..(Plot plan, showing size of lot, location of. syrtem_.in_relcttion_to..we#l.s,ib_.ti gs, etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pi permitted if pu lic sewer is avail bI within 200 feet,) <br /> PACKAGE TREATMENT [ � SEPTIC TANK s Size.. ./?�X.__g X --- <br /> SEPTIC Liquid Depth ._S�t�.l _�.,.__-_-- <br /> ,... 4 <br /> Capacity _j "Q hype ___ _ G�a_f - Material. Compartments <br /> -�---------------- <br /> Distance to nearest: Wett--_.__t5_ ?'------_--------......Foundation _.!Z --------- Prop. Line .......... kA <br /> ..LEACHING LINT= j No. of Lines: ; ..... 11'engt of each <br /> line.-----C-+A>.___._....... Total Length _J _�............. 0 <br /> I\ 'D' Box ------------ Type Filter Materidl le -----_--Depth Filter Material _48---------------------- <br /> Distance to nearest: Well:--_ _ ^_. _-.-•--- Foundation ... ............... Property line 4--------- -------- � <br /> SEEPAGE PIT [ Depth ._ .. -_----• Diaepete ; T _-_-. Number ---- -----••-------------- Rock Filled Yes �j No <br /> Water Table Depth --.__ . --------------------------Rock Size _./X------------ <br /> DistanceTto,r�earest:.'Well _-_---Foundation _f:�. ----___-.. Prop. Line-••--•--- <br /> _ __� --_---•- f' <br /> +... `_-�. - _ ------- ----------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------ ------------------------------------- Date ....................--__._-_---_-_) <br /> h <br /> Septic Tank (Specify Requirements) ---------- -----••----------------------••----------------------•--.-.----------•-..__.._.....--•---•--- - - <br /> ~ Disposal Field (Specify Requirements) --------------------------------___----------------------.._..----------------------- <br /> -------------- -- -----------•-•-- ----------•--•----------------------------•-----------------• ------------------•- -•--------------------------------------------•----..., ----------....------- --- A3 <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. Hoene owner or licen- JV <br /> "sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I &hall not employ any person In such mannm <br /> as to become subject to W7's Compensation laws of California." <br /> ..-- -•---- ------ --------------•------- . <br /> -- - <br /> 4 <br /> 3y ................. iNe <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-----•-•--•---•------------------•---.—. -------------------------- ----------------------.... DATE ---------------------------------------- <br /> BUILDING PERMIT ISSUED ---•-- --. _..._-•--- -- ---------•-------- •--•-•_-- -- <br /> .... __ .. _ DATE --•---- ----------------------------------- <br /> ADDITIONAL COMMENTS . �� 7Y.. . � 9C !7ac, -_�'�.----•---•--... <br /> - ------------------------------------------------- ------------------------ ----•----- . .- .----••----------------------------._..-------------------------•----------- -- -------. ----------------- <br /> - <br /> t., --------------------------------------- _ <br /> Finalinspection by: ....._... �`-------------- ---_------------------- ------•------•------•-•------------•-----------.-•-...__..Date ..... --� • 7 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> eo+f� <br /> "E. H.13 24 1-'68 Rev. 5M 7/72 3 M <br />