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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> " (Cornplewhi Triplicate) _ Permit No. __ ___----------------- <br /> Z__7AThis Permit Expires 1 Yeca From Date Issued Date Issued ..z-_ --------- <br /> Application <br /> pplication is hereby made to the San Joaquin Local Health District for a .permit to construct and install the work herein <br /> described. VVIs application is made ik-comFiliance witK,County Ordinance, No. 549-and-existing-Rules and Regulations. <br /> JOB ADDRESS/LOCATION ..._. '_-$0_----__._ <br /> ---- ----------------------- <br /> _CENSUS TRACT <br /> a <br /> Owner's Name .._ .]. QQ�,�. -Al _ Sf�3 <br /> - -------���-`.a.�'--------•--------- •---- - - Y_� -- - -------- --Phone - - - - <br /> Address ------ .. 0_ ' Le-�1- -- <br /> f �t City _. .... -r-- -----•--- <br /> t - <br /> Contractor's 4Nar 3 _, !?f� _ �'� o- - <br /> -=_==_-_--___.License # --/- -------f- Phone --- i'- 7 <br /> Installation will serve: Residence [+T'Xpartment House❑ Commercial ❑Trailer Court i❑ z <br /> � r i <br /> R � <br /> 0 .r Motel []Other ----------------------- <br /> I <br /> Number of living units:------/_-_ Nil�umber of bedrooms .__._--.Garbage Grinder- ------------ Lot Size <br /> --------------- <br /> Water Supply: Public System and name --- a.'1;_f pk, C.d ; <br /> - -------------------------------= Private ❑ <br /> Character of soil to a depth of 3 feet: Sand' . Silt Cloy N <br /> T ❑ ❑ y ❑ Peat❑ Sandy Loam ,❑ Clay Loam:❑ <br /> Hardpan ❑ i Adobe Gill Material ------------ Ifes <br /> Y ,type r:------------- <br /> (Plot plan, showi.ng..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,) q <br /> PACKAGE TREATMENT:;[ ] SEPTIC TANK'[ ] Size................ <br /> ------------------- ------------ Liquid Depth ------------------- U`y <br /> yCapacity ------------- - �. <br /> Type Material -- No. Compartments ----------- <br /> !Distance to nearest: Well' ------------------------------------Foundation . Prop: Line -._._.._ . <br /> LEACHING LINE ;._s -,�- r �,.> f o <br /> '-- <br /> [ No. of Line __________ -- Length of each line---------�1` Total Length 7_-_______ <br /> D' Box Ty-pe,fFilfer Material .�C p Filter Material --------���'----------------------- j <br /> . Distarice to-near`est:, ell �-.( e,( Foundation ____-!S70-.f._. Pro er i <br /> M,c �• - ;Property,-Line -A-S, <br /> --- --- - <br /> ---- --------•---- <br /> SEEPAGE PIT- [ Depth ----- 'S%:'- `~ Diameter -_ 3 <br /> I <br /> Number ------------- --j__,-___ _-Rock Filled Yes ®—No i❑ <br /> f <br /> -. Table Depth'- ­ ........- ----------Rock Size ---- <br /> --------------------- -- <br /> Distance to nearest: Well ;-:4.A---._w ---------------Foundation ...9 _f___-._ Prop. Line .._a R6 <br /> (Prev, Sanitation Permit# ..-_.'..:- ..___.:.__ ------------- <br /> . Date ...................... . ... <br /> Septic Tar&(Specify Requirements) --------- <br /> ------------------------------. <br /> - ------------------------------------- <br /> Disposal Field (Specify Requirements) ------------------------------------------ <br /> I / r <br /> •4 i5 * f ---------------------------------------------- <br /> -------------------- Y <br /> ----------- ---------- ) <br /> --- i <br /> ------------------------" <br /> - - ----------- <br /> (Dr -------------------- <br /> ``' aw existing and required addition on reverie side) _ w <br /> I hereby certify that l 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. Horne owner or licen- <br /> sed agents signature:certifies the following: <br /> "I certify that-in the performance of tlieYwork for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation Laws of California." <br /> x <br /> Signed <br /> --------------- <br /> BY <br /> ----------- -------------------------- <br /> ---•------------------- Owner <br /> --------------------- ---------- <br /> .: <br /> (If other,than o-wner) �. . <br /> FOR DEPARTMENT USE ONLY , <br /> APPLICATION-ACCEPTED tBY <br /> BUILDING PERMIT ISSUED --- ------------------ DATE ------ <br /> -- ---------------------- -------------------------------------DATE -------- <br /> ADDITIONAL,COMMENTS ---- <br /> f_� - ----------------•------------------------------------------------- <br /> ----------------------------------------------------------- <br /> --- -------------------------------- ----- <br /> ---------------------------- <br /> -------------------------------'~~ <br /> Final Inspection b -- -- ---- ------- - e --- �} <br /> p Y� ---- ---- - -- -- - ---- - - ----.Date ----SAN-­J AQ IN.=LOCAL' EALTH`DISTRICT- <br /> E. H. 9 1-'68 Rev. 5M <br />