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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .......... ................... -----•••••--•--- Permit No. -fl-Sa7S <br /> (Complete in Triplicate) <br /> ............................................:............. <br /> • .�..._.�- <br /> This Permit Expires 1 Year From Date Issued Date Issued -------- <br /> CPL--v G t <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construi_t and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> • { 1 <br /> JOB ADDRESS/LOCATION^-.. �. ,.......S... .-??tl:� ' ' .................................CENSUS TRACT .......... <br /> Owner's Name ....... Li �� lluzxf�. .r-----------------•----- _-Phone i-------.------ ................... <br /> Address ......... 2 ?_....-----S..........SF-1.D.N_ft�--------_----City ------ -- A <br /> --•----LD- --AJ- ---•--. ..............................-------•-•------ <br /> Contractor's Name 0QM6 ..... ..License # ......................... Phone <br /> Installation will serve. Residence[Apartment House 0 Commercial oTrailer Court K1 s <br /> f Motel Q',Ot. er:.._:.�:-- t1t -- �-.._. <br /> -Number of livingunits:..-../------ <br /> --.-Number of bedrooms ..Garbage Grinder . .. .._..._ Lot Size .. ._,._........ <br /> Water Supply:'Public System and name .f_t__. �_____ __. Private ®/ <br /> -- --•- -•-•---..._._... <br /> ,� w. ` <br /> Character of.soil to a depth of 3 feet: ._.Sand ..Salt E]'-: Clay Q-....Peat[]:. SandywLoam Clay <br /> Hardpan Adobe 0 Fill Material _A1q..."If yes,type -----•----•-.--.•-_-_--- <br /> 4 <br /> (Plot plan, showing size-of lot, location of system in relation -to-wells, buildings, etc. must be placed on reverse side.) A` <br /> s NEW INSTALLATION: (No septic tank or seepage pit permitted if public se10, wer is,availaple within 200 feet,) N <br /> I _ / <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size__-_ / <br /> _ J`a tiquld Depth <br /> Capacity Typek.rt+..t. Material-_ .ice-__: No. Compartments ...................... <br /> Distance to nearest: Well ------ ............. d__...._Foundation _.. ------ ---- Prop. Line <br /> LEACHING LINE [ ] No. of Lines �.__._.._.. Length of each line .. . ........... . T.otal Length <br /> ' _�epfh;FD' Box yS_ Type Filter Material Qr_cfilter Material ------ <br /> - <br /> Distance to nearest: Well __.:....__.. d Foundation �:�..__�__� ___-- Property Line. ...............-157- <br /> `' , <br /> SEEPAGE PIT [ J Depth ..�--.-._- -_- Diarr�eter�X._�__ Number .-_..:- -... Rack illed Yes M----No'1Q <br /> 1 `Water Table Depth ------------------------------�t .- Rock Size'. .x....... <br /> f"�"` <br /> --Dittos ce"16-neores!ar Well , Foundation ----�.�✓� -- Prop. <br /> Lina ---------------•----- <br /> REPAIR/ADDITION(Prev. Sbriitatcon.Permiitl# :..i.._�. ...u_�. ._.-. --.----. Ddte! -._.....-.•---._-...._-,�:�...... <br /> Septic Tank {Specify Requirements! -13fl� .-•--------- �:• - <br /> I. <br /> .. <br /> Disposal Field (Specify Requirements) .-. t�) 1!rTfRfl�Tl`A----- 4-Y�?Af�'.R) Al...... `�+('�. <br /> / <br /> ..................:.. ..........._.............................__........._..-.-__..-.....__^___..___-__._-_.._...._...._.-.s.............._... ...._... .. <br /> ! , (Draw existing and regvired-addition-on-reverse side! <br /> 1 hereby testi that I ava-ra ared this a lication�and that the work will be done in accordance with San Joagaia <br /> f5r h- .._P P, f ..�P_� <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or[icon- <br /> sed ageAts signature certifies the following: 1. a }^'! _" '�""''' <br /> "I certify that in the performance of the work for which this permitiis issued, ) shall not employ any person In such manner <br /> as to become ubject to?Warkman's C e tion laws of California." <br /> s <br /> jl ' <br /> Signed�4 `- --- -- - �. a Owner <br /> nes <br /> ` _ <br /> ByB ____ _ t .. ----- <br /> ! ! C r ca r �i •--•--.. _ •... e - -----... r '3y : rte. <br /> If other,than-owner T <br /> 1 ,` <br /> -FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By .......•T �'.....-----•---- -- ............................................. ...... DATE ` �� ---•- <br /> BUILDING"PEg:M[T'ISSUED':.,'.. "s._.�...._...'�..'...'::.___... .�._r _e......._ ._........_. ........DATE'-_._ __.. ..... . _ <br /> � <br /> ADDITIONAL COMMENTS .... <br /> f�TNS <br /> ot�7t1;F�....`:--:-���--..�.�..!�.-�tu�,�=t�='-:�---�1_-13:�•:-t�T`-...`�!�.�4-`.-•:1�1F•��P.�R-.•��,P�t'rc_•��..,�=`---- <br /> G. 1Grf 44ilk•.-----�tv]? X32�Y�-x!'!1`9 '----•----W 1- 33�T It 61-6.4-�A----1Tr--7WF . f <br /> 1.15.? 4 T1QA/- j6_- 1_-6C•rEt?- + r.9n[DI= XDIST trFinal Inspection by: .99f,4ACgb..-lacrH..-.. .�_`..-<AS,-- IR_-0- �. � -----.Date ------•---------•---------------•-----•-----SAN JOAQ N LOCAL HEALTIi <br /> E. H. 9 1-'b8 Rev._5M� Pk - <br />