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FOR OFFICE USE: <br /> ------ <br /> ----------------------------------------- APPLICATION FOR-SANITATION PERMIT Permit No. _7_�-':3�3 <br /> (Complete in Triplicate) ---` <br /> -----------------------W -- <br /> j� This Permit Expires 1 Year From Date Issued Date Issued .... <br /> ----------------• <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 i made in -I lis_ n_ce with County Ordinance No. 549 and existing Rules and Regulations: <br /> 2 �"), 0 <br /> JOB ADDRESS LOCATI r�___�.__R1Pi9._ d"' ----__iV I-I_-r�.-------- -p------•---.--•----CENSUS TRACT _ _�-5 _____ <br /> Owner's Name ------ 044-n 5------- - f�Lf�QAj-----•---------------------------------- ---•----. -------- ---Phone ------------------------------------ <br /> Address ------------/17-----J ------Al1gI N----------------------------------------------City. �1 LY. - <br /> Contractor's Name -----------©WAI E - -------------------License # ........................ Phone _.._.......................... <br /> Installation will serve: Residence[lpartment House❑ Commercial ❑Trailer Court ;❑ <br /> J Motel ❑Other ------------------------ -------------------- <br /> Number of living units: .... Number of bedropms ,_:.Garbage Grinder -ko-_- Lot Size ----1+!MF -6F---__________ <br /> Water Supply: Public System and name ---------=---------------------------------------------------------------------------------------------_-----Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ -Peat❑ Sandy Loam e Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material _-M- If yes,type ____________________________ <br /> (Plot plan, showing size of lot, locatio of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION- (No septic to seep pit permitted if public sewer is avail ble within 200 feet,) <br /> PACKAGE TREATMENT [ 7 SE [ Size________________________________________ ______ Liquid Depth -------------------------- <br /> Capa .--_ - --- terial---------------------- No. Compartments ...................... <br /> Di - -- .. _____________Foundation __-_ ----------------- Prop. Line -------_........... <br /> LEACHING LINE [ ] n f each line_______________________ ____ Total Length ___.._.____.-___........... <br /> ox I ____________________Depth Filter aterial i-------------------------------------------- <br /> to I -- ------------------- Foundation ------------------------ Property Line ........................ <br /> SEEPAGE PIT [ J Dep ----_----_---- ____ Dion eter ................ Number -------------------- ------- Rock Filled Yes ❑ No (7 <br /> Water Table Depth ----- --------------------------------------Rock Size ------- ------------------------- <br /> Distance to nearest: Well Foundation '___ Prop. Line ______________________ <br /> I <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ________ -----______________._______- Date ___________"___ __._.__.________) <br /> SepticTank (Specify Requirements) --------------------------- •-,------•--------•--•---------------•----------=- .......................................................... <br /> Disposalyetd: (Specify Requirements) ----- �1T L1'N�-----1// D- Q_ 4. <br /> D_WRQ _ <br /> -P h =" R A '------5 --`--_.-__ �'F _��* �D-------1-�'�`� �1.. <br /> ------------------- ==-------------------------------------------------------------------------------------------------------------------------------=------------------------------------------------ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify',ti t I have prepared this application and that the work will be done In accordance with San Joaquin <br /> Coynty Ordinances,State Laws, and Rules and Regulations of the San Joaquin Loco[-Health District. Home owner or licen- <br /> sed agents signature";certifies the fallowing: <br /> "I certify in pe o nc of the work for which this permit is issued, I shall not employ any person in such manner <br /> as:_fo be e s A to k n Compensation laws of California." <br /> Signe - -- :---------Q ----------------------•-•-----•-------------------------- Owner <br /> -------------- ----- --c- - ---�L-�-- ---- Title --------------- -- ---•------...---------------------­-------- ------ <br /> (Iflother than owner) _ <br /> FOR DEPARTMENT USE ONLY �- <br /> APJ'LICATFO*AACEPTED BY <br /> . f r--------� � <br /> BUI ► DI <br /> ITE <br /> _v <br /> ADQAL COJ�MENTS -. ------------ -------`-------- .y.. .�. <br /> ..... <br /> __:_---------•---------- <br /> ----------.----------------------------------- --------•-------------•---------_--___-t-------------------------------------------------------------------------------------------- <br /> Final Inspection by: ------------- - Date •�' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.`9 1-'W6v. 5M C� <br />