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FOR OFFICE G APPLICATION FOR SANITATION PERMIT <br /> J727� -,r_ /� -., Permit No. = t <br /> �- (Complete in Triplicate) <br /> r i� 31-� <br /> r <br /> - }NL�-- -----�--�-�- Date Issued ---�---��--- ---:. <br /> ------------ --- ------ <br /> I <br /> This Permit Expires t 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 tic tion is de in �o fiance �TCunty Ordina eNo-5a9 and existing Rules and Regulations: { <br /> PES�S <br /> JOB 461) LOC T ON r _�Q_--' <br /> ?;119 _ ,.CENSUS TRACT -------------- ----------- <br /> Owner's Name (�- --------------- - Phone <br /> U� �= - <br /> ,: ' <br /> Address -d�-�L�/�'-�/1�.�-S'� " -��---- - ------------- ----•---. City -���-� f��--------------------------------------------- <br /> Contractor'.s <br /> ---------- --------------------------------Contractor's Name --- lQf_ lf"OGP�/-----------------------------------= <br /> --------License #146Y.;?99--_ Phoney,16 <br /> Installation will serve: Residerice Apartment House❑ Commercial :❑Trailer Court <br /> Motel ❑Other - 1 <br /> Number of living units,.---/-.__Number of bedrooms --_Garbage Grinder L/4-,57. Lot Size �----•------- - <br /> Water Supply: Public System and name ------------------------- --------------------------------------------------------- Privatej' <br /> Character of soil to a depth of 3 feet. Sand❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- <br /> � f <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 1 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if,publIic sewer is available within 200 feet,)LZ/ <br /> PACKAGE TREATMENT {;] SEPTIC TANK 1(f Size_- rx_ -----__._-_------ - Liquid Depth �---------------- �1 <br /> i <br /> capacityZa __f _ - -�_ ater <br /> Mia!_ �lj_�--___-- No. Compartments _ ----•-----=---- k <br /> � . <br /> V1- ---- Type <br /> l r <br /> Distance to ,nearest: Well -. �- �.,-_-__�---------------Foundation va--.Prop. Line - __ __ - ------ <br /> i 1 <br /> �� <br /> LEACHING LINE No. of Lines -__- ----__-------- Length of each line------ — ------ Tota) ,Length ----- ------------- I <br /> i i. <br /> `D' Box �fdf:z.-_ Type Filter Material l --1 Depth Filter Maferiaf �— ----------------------------•---- <br /> '� Distance to nearest: Well -__ f�___-- ------- Foundation / --_-___-__.---_-_ Property Line - �-------------- I <br /> - y i �• <br /> SEEPAGE PIT NA Depth 4--o2-„J--------- Diameter ,✓���------- Number _.�?---------------------- Rock Filled Yes No 0Water Table Depth ----- ----------------------------------- Size ------------------ <br /> ' I ----Foundation __ `c�Q-_-------- Prop. Line __� _-..---i--- <br /> +Distance to nearest: Well --__-.�.3Q--------------- - <br /> I -) <br /> REPAIRf ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date _--------------.---------------- <br /> Septic Tank (Specify'Requirements) -------- ----- ----------- ------------------------------------------------------- <br /> a <br /> Disposal Field (Specify Requirements) ----------- -- ------------- ------------------------ <br /> ----------------------------- -------------------------------------------- ------------------------ <br /> -------------- <br /> �_ <br /> -4---- ------- -------------------------------------------- <br /> f (Draw existing and-required addition 6ri`r6ve'r`$e side) <br /> i plication and that the work will bte;done in accordance with San Joaquin <br /> I hereby certify that I have prepared,this..ppp <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joacljin local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the wor ,--for which this per`mif-is'issued,-I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California.” <br /> Signed --- ------------------ --------- Owner <br /> -- ---- - ---------------- Title <br /> r n owner) _. <br /> (If other .' <br /> FOR DEPARTMENT USE ONLY 9 <br /> ARPLICA7ikCN ACCEPTED BY DATE __. I-- <br /> -- - --------------------------- ------------- <br /> BUILDING PERMIT ISSUED ------- ------- DATE . <br /> ADDITIONALCOMMENTS -------------- -------------- --- ----------------------------------------=--------•----------- ------ <br /> ----------- ------------------------------- ----------------- ------------------------ <br /> -------------- :2 '_._ <br /> ------------- ------- -------- V ­-------------------------------------- t <br /> k Dae ' �" �---- <br /> Final Inspection by: ___________ __-_ <br /> Q <br /> SAN JOAIN LOJL`HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev:-5M. - v C <br />