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FOR OFFICE USE: <br /> I APPLICATION' FOR_SANITATION PERMIT <br /> -•--------------------- Permit No. / <br /> -(Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Date Issued <br /> _ __ <br /> ---- -------------------------- ------------- ------. <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein . <br /> described. This application is made in comp <br /> li <br /> ance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION ----------- '4<4........CENSUS TRACT __ --�'�-------- <br /> ----------------- <br /> Owner's Name .-----_ -eOV _z---S 4 -------------- --------------------------= ----.--Phone <br /> Address ----------------- - •------------------------- — s t------------ City ----------- ---- _-------------------------------•---J--- ...... <br /> Contractor's Name S ~ ' ---.License # one - F- <br /> Installation will Re <br /> serve: sidence Apartment House❑ Commercial E]Trailet`Gurt =❑ <br /> ;.�Motel ❑ Other =:------=- '= t <br /> Number of living units:__________ Number of_bedrobnii•-~__.-Garbage Grinder ------------ Lot Size 1 X/1 3------------------------ <br /> �l ;;; ------------ -- Pi <br /> Water Supply.. Public'5ystem-and:,na a°'-___'_______ T Private <br /> Character of soil to,a depth of 31feet: Sand' Silt❑ Clay_•E]"11'Peat❑ Sandy Loom-!D-•-,C1dyAoam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material _.__ ------- If yes,ktype --------------------j-- -_-- <br /> (Pl'ot 1plbn, showing size of lot, location of system in­relation to wellsl�l vildings, etc. must be placed on, reverse side.) <br /> � I <br /> NEW,INSTALLATIONa (No septic tank or seepa it permitted if public sewer is available within 200 feefi,) ! , <br /> PACKAGE TREATMENT ] SEPTIC TANK' Size__�X_YX/!?------------- - -- <br /> { qq ------ Liquid .Depth ----- ` <br /> Capacity i:20ca----------- Type'.7_�?--- Materia--awcre ----- No. Compartments, :1-------.:----- <br /> Distance to nearest: Well _ _C >r _-----_____"______',+Foundation _f?"""_---------- Prop. Line ___. ___:._------ <br /> LEACHING;LINE [' No. of Lines ---�'4 ._.-______----,Length of each line--_---- ----- -____ Total Length <br /> y ..__ O___.._-___-- <br /> i I� <br /> 'D' Box Type Filter.Material -"-Depth Filter Material -------------------- _ ___::._______--___._ <br /> Distance to nearest: Well Foundation ___/0______________ Property Line ------------- <br /> De th ���r��________ Diameter Number--______Z_______________ Rack Filled Yes No ❑ i <br /> �6 [ ) P / -- wy <br /> �4��h Gear Water Table Depth -----6------ --- ' -------------------Rock Size -------------------------------- <br /> - _ ------. Pro Line __L1---f------ -- <br /> Distance to nearest: Well ____ _ _---- ------------------ Foundation -- ----____ <br /> r Zo { <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> ---------------------------- ... '----------------------- <br /> it # <br /> ISe tic Tank 5 ecif Requirements) i <br /> Disposal Field,!(Specify Requirements) ------------------------------- ------------------------------------------------------------•-------------- <br /> ! K <br /> - -------------------- <br /> ---------------- - I----------------------------------------------------- <br /> -- -- ( -- ----- g <br /> i --.- - - -------'----- ------------- '-- .----------------------------------=----f----------------------------------------------�----------------------------- <br /> I hereby certify that I have prepared this application <br /> required addition on�r'everse side} <br /> Draw existin a <br /> on and that the work will be done in accordance with San Joaquin <br /> County.Ordinances,.State Laws, and Rules and.Regulations.of fhb San J.ociouin Local.Health District. Home owner or licen- <br /> sed agents signature certifies the following: ` 4E t <br /> "I certify th t in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> IG as to bec subject ro Work an sZ <br /> nsation laws of California." <br /> Signed ---- --- ------ - --- -- <br /> ' --- ------------------------------------- Owner <br /> r <br />' BY ----------------- ------ ------• Title -------------- ----------------------------------------- ------------ <br /> (If other than owner) <br /> FOL11 DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------- ------------• -------------------- -------------. DATE --------- -2/ <br /> ---------- <br /> BUILDING PERMIT ISSUED ------------- --------------------DATE ---- -------------------------------------- <br /> ADDITIONAL COMMENTS ------ ^vr� _ <br /> ---------------------------------- --- =.� - � -- �--- <br /> I •-------- <br /> Final Inspection by: --- - ----- Date d i _,%� ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />