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FOR OFFICE USE' "III APPLICATION FOR SANITATION PERMIT <br /> _... N. <br /> Permit No. <br /> p <br /> (Complete In Triplicate) <br /> d. This Permit Expires I Year From Date Issued Date Issued ......-.....-.... <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application 1i made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> / .t. p —7— I <br /> JOB ADDRESS/LOCATION .../..fes. ..L..ls....1.4....1.!�!A .... Q--_..... ........ ....... .....CENSUS TRACT ............. . <br /> Owner's Name ------- ........... <br /> ....... a....L/1r<..f. . L�.£ - ............... -............ .. . . Phone ...Lo7-L.- T�//._. <br /> r ....... L? <br /> ­tAddress ....-._..-................. /D12..x........--.......... .... ------.. Clt ..F.-.!.Q.�6..._... <br /> Contractor's Name .. ...:_7Ak. :/l.?i9kfd13A..-R. O.f?wS.:..'t /1 .....License ;it ........................ Phone 0.7. <br /> Installation will serve: 1 Residence Apartment House Comdtercial[]Trailer Court <br /> �( Motel [3 Other.. ....................... <br /> .:........................•---..... rat s� 4. <br /> : <br /> Number of living units:.....:#.. Number of bedrooms ...f.+....Garbage Grinder ....:..:.... Lot Size . ar— ...... <br /> Water Supply: Public System%nd name ..................................-............-------........................................................Private i <br /> Character of soli to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ . Clay Loam ' <br /> t 1� Hardpan ❑ Adobe Fill Material _:......... If yes,type............................ i <br /> 1 <br /> (Plot plan, showing size of lot, location of system in relcition to well; buildings, eta must be placed on reverse side.) y <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK I ] Size.............`.......................... . Liquid Depth ......................... i <br /> Capacit".................. Type ... ............Material.................... No. Compartments .--.................. <br /> Distance to nearest: Well,-,.... ................... ..........Foundation ...................... Prop. Lina.....................N <br /> LEACHING LINE [ ] No. of lines ..................... .. Length of each (Ine.----------------.----- .... Total Length <br /> s. <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ........................................... <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ....................L lV <br /> SEEPAGE PIT [ J Depth .................... Diameter :............... Number . ...................._.... Rack Filled. Yes ❑ No <br /> Water Table Depth...................:.............................Rock Size ........... .............. ..... 1 <br /> Distance to nearest: Well .:...............:......................Foundation ................... Prop. Line ............:........ <br /> p <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..o........o........:...............---- Date ...........................4......I <br /> Septic Tank (Specify Requirements) .. - .f. .T .�a' ....... .. .. ...................... ............._ ------------ <br /> 11 <br /> Disposal Field (Specs Requirements) �!-4-{.?�?- -p�> �l f:' •••••• ---/.`.�S Lf-/-- �f�-.4.Q..•-`.•.•-•.•/•_•••••...... •.•-• •••••-•i•�- <br /> `/ <br /> �.WO / .. <br /> /... ..�, ._._ . �.. ....... .... .....,......---------......._ ..:......I... <br /> dditI <br /> (Draw exist g an equired ion on reverse side) <br /> 1 hereby certify that 1 have ilrepared this application and that the work will be done In accordance with San Joaquin <br /> County Ordinances, State laws, and Rules and.Regulations of ths'San Joaquin' Local Health District. Home owner or licem <br /> sed agents signature certifies the following: <br /> s. <br /> "I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person in such manner <br /> as to b me sub-ecf M./*c�cjIman's Compen laws of California." <br /> Signedv�.c.// ..r...1.l..K- (2.1, .N....'f' ©.f/fin.. ...,Q.9C... Owner .. ' <br /> ...�... ......... . . _ 0� .... Title .. . .. ............................ <br /> i <br /> (If other than o3iner) I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYI__ ..-...-..0 c'- ....... ._._..... ..... -........._ ........_--------. . ........... DATE......iZ..LB ..................... <br /> BUILDING PERMIT ISSUED ..Ir. ... . .. /-... DATE ........................ ...!... <br /> ADDITIONAL COMMENTS ....7P..�J..4lG�a�..�Lu�h_ ..... - - .................................... :........................... <br /> 4 <br /> .. ..................... .......... ...... : <br /> Final Inspection by! ............CX............................................._....' . <br /> ..... ........ .... . ..................Date . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT = s' 90V <br /> -r-u-13 241_,a n_._ - <br /> -- i <br />