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{ <br /> u4OR OFFICE USE. _ <br /> APPLICATION FOR SANITATION PERbUT <br /> :. ...................... Permit No. .. 3 9S <br /> J ICompieteiritriplicatel <br /> .... ..,.. ............................. -7 <br /> 3 <br /> ------------------------------1 This Permit Expires I Year From Date Issued <br /> Date Issued ..�.t <br /> Application is hereby made to the San Jt 66quln_Local-Health District,for a permit to construct and install the wo`rk�herein <br /> described. This application is made in compliance with-bounty Ordi nce No.. 519 a existing Rules and Reguldtioris: <br /> i <br /> JOB ADDRESS/LOCATI N ,._........... `L 4% ���.. y..... �c E".�_. ENSUS TRACT .......................... <br /> i _._.. LL.._. �. _._ <br /> Owner's Name ........ . .'- /-_. al r �f ...... ....................... Phone <br /> Address --'...........:. R..-o <br /> � � �G �f� h:� GtY ---� - •- -- •-•----._.._... . ....--•---........ <br /> Contractor's Nam .. . ..-:_.. rO� ............... License # /�� ,,�...._ Phone ......_. <br /> Installation will serve:. Residence ffyApartment House Commercial oTrailer`,Court 0 <br /> J Motel ❑Other .._......_.. •---•-•-•................ i <br /> G <br /> Number of living units------ Number of bedrooms ...-_.Garbage Grinder --- lot Size . .. ... ....... <br /> I Water Supply: Public System and name ..- -•-----------'-•--••---......'--------------------------------......--•---.......-•--------- .......Private ®� <br /> Character of soil to a depth of 3 feet: Sand C] Silt❑ Clay Peat❑ Sandy Loam fl Goy Loam <br /> ' Hardpan❑ Adobe- ill Material�U.. If yds,type ..__-_-...__--------------- <br /> 4 .1 <br /> IPlot plan', showing size of-Iot, location of..system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> 44 <br /> NEW INSTALLATION. (No septic.tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENTT[) SEPTIC JTANK 1A,-- Size..... , / ................ Liquid Depth ... _/...�.._........__� <br /> `d Capacity !-��...... - Type .• Material _. z- ,�r c�Rto. Compartments .. ..t,......_...__ <br /> Di ante to nearest- Well ......................Foundation'.... ------- Prop. Line S.z............ <br /> LEACHING LINE N of�LLines _.._ ............... Length of each line..{ __ ....... Total len th ,1 ........... <br /> 'D' Box� Type Filter Material � .._.Depfh Filter Material ..� ................................. - <br /> ' ; --Distanc`e to nearest- VVeii ''` --------- <br /> SEEPAGE <br /> '� "I- dfl6n ..412. Property Line .... .................. <br /> } F <br /> SIfEPAGE PIT . Diameter ... Number Rock Filled Yes <br /> ' Water Table Depth ', ..Rork Size . .J� -------- <br /> ... <br /> Distarice to nearest: Well ................Foundation ...ZD--------- Prop, Line-•;i................k. <br /> 6 <br /> I REPAIR/ADDITION(Prev. Sanitation Permit _.---• Date --) <br /> SepticTank (Specify Requirements) .............s............................................................................. ...... ......................................... <br /> Disposal Field (Specify-iRiquirementsl,:�: - -•...................... ..................•--- ...........................••...................................... <br /> ....., <br /> •---•----------------- <br /> `. -" . — ..........�.—:--------��------ ----------=--=--- - i ----------------. ............... <br /> --'*----.._....... .... <br /> .(Draw 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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation haws of California." <br /> Signed <br /> .� - Owner /� <br /> g ..-----.. ... ........-• ............:..... <br /> I By .. .._..._........`........ .-- ---•--•------•- <br /> Title <br /> if a tan owner <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTEDBY ....`_. . -• <br /> • •••- <br /> ........... ..• DATE _. ..�--- <br /> BUILDING PERMIT ISSUED ..__..... - --•-------- ... ...................................................DATE ....... ................................... <br /> ADDITIONAL COMMENTS <br /> ........... ................. ...•-•---••--••-•--••---••------ .. :.-. . -------•-...................­......­..­...1.................. -- --- ....I-.----------_---_---­---------------_---'.. <br /> ---------------- ------- ...... . ..... ... <br /> ...............-----...•---.........__........ <br /> ----------------- ------ <br /> Finalinspection by: ........•-� :..--......_ ....... ... ............................................Date .... ... ..........•--- ........... <br /> __SAN.JOA IN LOCAL HEALTH,,DISTRICT <br /> r <br /> c :1 13 24 1_-Aa o— sAA 7172 3 M <br />