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�91Z OFFYE�USE: APPLICATION FOR SANITATION PERMIT <br /> .- Permit No. <br /> - <br /> ....... 5---- - --- ----------------_------ <br /> (Complete in Triplicate) <br /> -- --- ---------------- <br /> ---------------------- - Date issued <br /> This permit Expires 1 Year From Date Issued b5 <br /> ------- - 02( — (�O - <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 a in compliance with County Ordinance No. 549 ond�xisti g Rules and Regulations: <br /> [Get 7M.tL NSUS TRACT ------ --- -------------- <br /> JOB ADDRESS/LOCATION „-- --------- <br /> --- ----------- <br /> Phone .J .... .5cr�o..•--- <br /> Owner's Name ------ - <br /> - -G9� <br /> . - " �� , <br /> rr�-�---� - ---- ._ _ .:. . �- -------- ---------------------------------------------- <br /> Address ---- - ---- --------- -------------- --------._ . City <br /> #// '-z <br /> _ <br /> Phone <br /> Contractor's Name --- -------- --- -.� "� - <br /> --- - <br /> ------------------ -------- - --------License <br /> Installation will serve: Residence 'Apartt ent House❑ Commercial ❑Trailer Court <br /> Motel Q Other --------------- <br /> ------------- ------ _ <br /> Number of living units:.�J�Number of bedrooms•`Garbage Grinder ./. -------- <br /> Lot Size ---- <br /> Number <br /> -- <br /> y Private [:1Water Supply: Public System and name �1 d9i _ / <br /> f f <br /> Character of soil to a depth of 3 feet: Sand.0 Silt 171 � Clay ❑ Peat Sandy Loam ❑ Cla Loom, <br /> 1 <br /> Hardpan ❑.�' Adobe.. :mil! Material ------------ if yes,type ------ ----------- ----- .� <br /> (Plot plan, showing size of lot, location ofsystemIn relation to wells, buildings, etc. must be placed on reverse side.) (, <br /> NEW INSTALLATION: (No septic tank or seepage'pit permitted if public sewer i�a ailable within 200 feet,) ,� l <br /> 1. r t . Liquid Depth tf t.---------- <br /> Stze-----� A4�---- <br /> - q PPACKAGE TREATMENT SEPTIC TANK'[`], " ------- <br /> Capacity�� TYPe ------ - f'� MateriaNo. Compartments t. _� / <br /> GvJ -----Foundation Prop. Line -. ----- <br /> Distance to nearest: Well __��/�-=-- --- <br /> i Length of each line. ._ � _.�'J----. Total Length __ . -- -•t <br /> LEACHING LINE No. of Lines --.------1 - ----- g --- .4, <br /> ,��� _.. , <br /> t .- ,,d�epth Filter M terial L .................�_ _-_---_-. <br /> f + D' Box Type Fitter Material/ 11�,( <br /> 10 _7 Property Line � . _�u�__i• � <br /> Distance to nearest: Well ----- <br /> --- Foundat•od. _.� -- ----- '� <br /> '% ..._ Rock Filled Yes` No <br /> Depth --- Diameter ---------- ----- Number.....---- ------ .� <br /> SEEPAGE P17 [ ) P ---- -- ------- • t� �, • � <br /> Water Table Depth Rock Size <br /> " - Foundation. ----- Prop. Line --- -------------- <br /> Distance to nearest: Wel! ------------------------ <br /> r- - <br /> te _----:-•-=---- ) ...� <br /> REPL.�R/ADDITION(Prev. Sanitation'Permit#.--'-�"�----••-"- a_ <br /> tt _.. - - ---- - -.................. <br /> Septic Tank (Specify Requirements) --------- -------•�-•-----••----- ------------­-_-----:�3 --•---- - <br /> _G.. -r�...a .._.. •------ -- <br /> Disposal Field (Specify Requirements) ___-----------------------------____�_.--............. <br /> --- r - <br /> f - _-- -- --------- ---- -- ---------- <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;occordance with San 'lJaquin! <br /> County Ordinances, State Laws, and Rules and Regulation of the Son Joaquin Local'Health•District. Home owner or licen- <br /> sed agents signature certifies the following: r ,� ' -' ` f <br /> "1 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 Workman's Compensation laws of:CalI. r . 1,1. l <br /> Signed "'------ Owner <br /> B _ Title ; -------- -- ---�- <br /> ----------- <br /> (If other than owner) �y <br /> r r. <br /> -----"FOR`DEPARTMENT�USE ONLY <br /> APPLICATION ACCEPTED BY .. /`.. J v �d ..... -•-_.. DATE . . .�y-" .. <br /> -- <br /> ...4 DATE -1 <br /> �� - a -----..--:•--------- <br /> BUILDING PERMIT ISSUED _.__ e_ . . _ - ........ <br /> ADDITIONAL COMMENTS ....__'-••--.. ----------- -- ---------- --------•-•-••-------•--------__,..•__- n----- = <br /> = -- .......... <br /> f -------- ----------- <br /> t -} <br /> FT ---- <br /> d' <br /> -•-------••-•----- ••-------------- - - to -- --- ---- --------....__. ---.- <br /> Final Inspection by: .. — - . - - - ------------Da <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t <br /> E. H. 9 1-'68 Rev. 5M <br />