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S J. <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -2 <br /> Permit No. -/�J--'--�-�-� <br /> ----- ------------- ----------------- ------------- (Complete in Triplicate) <br /> ---------------------------------------------- <br /> --------------- Date Issued <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 co,,,,mffpliance with County Ordinance No. <br /> 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .-- ----- jv----- ----`-.__TC1---._CENSUS TRACT - - - _- <br /> Owner's Name �Z 5 _Oz. —- ---- ------------------------------------_-------- Phone <br /> --------------- <br /> s. <br /> Address iv Cit 1'7 j9/1/_ .e G ----------------------------------- <br /> RXContractor's Name ---_C:!',_% �- l` -- _.License #Q'r ��--- Phone =- ��- <br /> Installation will serve: Residence ®Apartment House❑ Commercial ❑Trailer Court l❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:_- ------ Number of bedrooms -_77---Garbage Grinder -~�-- Lot Size --- '_____-------------------------units:--/Water Supply: Public System and name ------------------------ ------------------------------------•---------Private 8 <br /> Character of soil to a depth of 3 feet: Sand ® - Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ._Nj1 -- If yes, type ---------------------_______ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT [ ] SEPTIC TANK.j Size---------------------------- ----------- ------- Liquid Depth ------------------------ <br /> Capacity ---------- - <br /> _----------------------Ca acit -------- T _ Material---------- ----------- No. Compartments --------------.------- <br /> Distance to nearest: Wel ------------------------------------Found tion ---------------------- Prop. Line --------------.------- <br /> LEACHING LINE [ ] No. of Lines -----------r-:---- .-- Length of each line--------- ------------ ----- Total Length ------.---- ------ <br /> 'D' Box .----------- Type Filt r Material --------------------Dept Filter Material -----------------------------------.-- <br /> Distance to nearest: Well ------------------------ Foundation -- ------------------- Property Line ------------------------ <br /> SEEPAGE PIT [ ] Depth ----------- -------- Dia eter ---------------- Number ---_----------- --- Rock Filled Yes El Na �❑ <br /> Water Table Depth ---- ---------------Rock ize -------------------------------- <br /> Distance to nearest: Well ---------------------------------------.Fou ation -------------------- Prop. Line <br /> --•-------------•-••-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit�# -------- ----------------------------------- Date `--------------- --------.-------1 <br /> l� � � {-------P _4!---On r�-e��/C� <br /> Septic Tank (Specify Requirements) _____/- !- _ <br /> Disposal Field {Specify Requirements) ­4�.W*------------/fJ------------------ ...... � �-------------- --------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------- <br /> ---- re ---------------------------------------------------------------------------- <br /> (Draw <br /> ------------------------- <br /> 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. Home owner or licen- <br /> sed agents signature certifies the following: <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 become subject to Wor an's Compensation laws of California." <br /> Signed -------- - - --- --------------- --- -------------------------------- Owner <br /> BYL.a' ------------------------- -Title _----------------- --------------------------------------------------- <br /> (If other than owner) , <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----J1 -45974-------------------------------------------------------------- DATE ---f ~..k ---------- <br /> BUILDING PERMIT ISSUED ---------------------- ------------------------ <br /> --------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS _ ----------------------------------------------------------------------- <br /> ------------------------------------ ------- ---------------------= ---- ------ ------ - - -------------------------------------------------------------------------------- - <br /> ---------------------- -------------- --- - --- --- - t } <br /> Final Inspectio Dae ---- ----- --- ---- <br /> Final <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br /> f x <br />