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• <br /> FOR OFFICE USE: ^r <br /> APPLICATION FOR SANITATION PERMIT qq <br /> ....... .. .... .�.f.'_...t.�..s <br /> - � - (Complete in Triplicate) Permit No. <br /> — % •' Date Issued <br /> ........ This Permit Expires i 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATN .SSJ� ^ .._ IU S.�_TH.Lf�.N.D_____.____ -_.....CENSUS TRACT ._5.-. �. ...... <br /> Owner's Name ....... IQ <br /> . Q H N/........SMI TH...._. ............. ....... ........ . --- ---- .. ...........Phone - <br /> Address ......5555------ ----�JO RT.f-3--11W.-D............ City ...Mr4.nl.TECn......................................... <br /> . . .... ..............•--••... -- <br /> Contractor's Name ...Fwl-L-J �-._.�� - .--[ �........ ._--- -.---.License # _.- . ................ Phone . ............................ <br /> Installation will serve: . Residence XfApartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other .. r <br /> ti . . <br /> Number of living units: ....... Number of bedrooms Garbdge Grinder ..--. 0... Lot Size ......l~DQ 4--- <br /> Water Supply: Public System and name .... - --. .-..;.`. -----------------------------------------••--•--•_..,.....Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay,[ Peat F Sandy Loam V Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ 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,) I <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] .� Size..... ............. _ ,..Liquid Depth .......................... <br /> Capacity --------------- -- Typ . Material- _.`�:.. � No. Compartments + <br /> Distance to nearest: Well ... ..................................... .......Foundation .. .. .. . .. Prop. Line ..... ....._.... <br /> LEA HING LINE [ ] No. of Lines --------- ----------- . Length of each line..--_.................. Total Length .... ...... <br /> 'D' Box ......-.---- Type Filte Material ....................Depth Filter aterial ......__..........--...�J......... <br /> Distance to nearest: Well .- . - .._...... Foundation Property Line _-... ...... <br /> l <br /> SEEPAGE PIT [ ] Depth Diameter '-._...... . - . Number ..........k Rock Filled Yes ❑ No ❑ <br /> Water Table Depth . --- .... ----- ............. ---.Rock Size --- ,-------I......... I <br /> Distance to nearest: Well ... ......_ .._..___ _ Foundation .... - :..-.....-. Prop. Line i............-.. <br /> REPAIR/ADDITION(Prev. Sanitation'Permit#--7 "' :- Date-.-.--:..—. <br /> - = ) <br /> Septic Tank (Specify Requirements) - ................ <br /> Disposal Field (Specify Requirements) -----�L :_.- X_..-_;-,, 1�/ r.-_-41. ..._...;...�V.......---_....................-.. <br /> A D.D i T.-t o NA-L L E6-c4....---_j.N.F................................................ w <br /> � A------._.......__:........-- ------------ <br /> - .. . . _. --------------------- <br /> (Drow.existing and required addition_on reverse side) ..Al� <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 /> ­F certify i1hot,*n the erformance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to becubject orkman's Compe�tion law f California." <br /> Signed --. . LL-I—I RE_.__�,.ON ....7 t. ..... Owner <br /> By ------- --- - ----- . --------- ----------------- _ Title .-- . - -- --- --------- ................. .-..-....... <br /> (If er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY�.. L— LS1FN................. ..._. -_ ................... DATE .... 7/ ... <br /> BUILDING PERMIT ISSUED-:o. ._.: . ------- - ....DATE ,.......- r:....t,,.. ...- <br /> ADDITIONAL COMMENTS ____ - <br /> ............................................... .... .._-............_.--.-..-..-.....-..........................-..--.._........_....._.....----.......•-_-.....-..-...--.--••_-_-------.-..._ <br /> ....._-_ -.___--...-•---_._............ -. .�. ......__._ ----- ------------------------------ ---- <br /> Final..Inspection by: ........./�- _._.Date '2�._!,_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1•'68 Rev. 5M <br />