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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------------------------- <br /> (Complete in Triplicate) Permit No: <br /> .______ _ <br /> ._ _____- This Permit Expires 1 Year From Date Issued Date Issued - _- - ..�-+ <br /> [ <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 /> iG-,F° i � 4451 <br /> � I nn -- // <br /> JOB ADDRESS/6CATION /f C?, o�l/e 445 __-/M,fle _6u/�._oT-40e4 yCENSUS TRACT ------ ----------_-.---.- <br /> Owner's Name . l�Rth?)C <br /> ,/'ecl "f�lP. ­---------------------------------- ------- -- --- Pho�n}e ------------•---------•---- <br /> Address ._�'�� � c� 441 (210111/ j / 9 City ---------------- <br /> '. r� <br /> Contractor's Nae CAi4_`_/9/. �i� '(r I`� ,,__/' -L___.License # �____ Phone - � /-�____ <br /> 4 <br /> Installation will serve: Residence Z Apartment House[] Commercial ❑Trailer Court 1❑ <br /> Motel ❑Other --------------------------------------------- _ // �.w <br /> Number of living units:---- ---. Number of bedrooms _.y---Garbage..Grinder __A -.- Lot Size -----_______________________________________ <br /> Water Supply: Public System and name ------------------------------------------------------------ ---------------------------------------- <br /> Character <br /> -------•------ ----------------------Character of sotl to a depth of 3 fest: Sand❑ Silt.O Clay ❑ Peat❑ Sandy Loam .❑ Clay Loam, <br /> 1-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 itank or seepage pit permitted if public sewer is available within 200 feet,) a'/ <br /> PACKAGE TREATMENT [ ] SEPTJC TAN�L I Si�_/D4,0--���e .-- Liquid Depth '' ___f���__ <br /> Capacity1 - jaez -- TypeMaterialo P ------r% <br /> f � _� 4lR__a� / __ ._ �_ No. Compartments �......... <br /> Distance to nearest- Well _______` ___________________Foundation _____�___________ Prop. Line __-__._______.___.__ <br /> LEACHING LINE [`J No. of Lines .___�_ ____________ Length of each line______ 4�''_`----------- Total Length ,______��� r <br /> r 'D' Box ----1----- Type Filter Material �44V__?C_Depth Filter Material .-_._ .__-------------------- <br /> Distance <br /> _.-__-.............Distance to nearest: Well f_______ Foundation -------/'0----------- Property Line .__�............... <br /> i <br /> SEEPAGE PIT [ ] Depth _____ ______. 'Diameter ___ _________ Number .___._-_--y------------- Rock Filled Yes ( No 0 <br /> Water Table Depth ________________________________________________Rock Size _---_04ewle.7 ' <br /> Distance to nearest: Wel! ---------�00-1 <br /> -------------- <br /> ------ Prop. Line --- <br /> REPAIR/ADDITION(Prev. Sanitation;Permit# -------------------------------------------- Date ----------------------------------) <br /> t' <br /> Septic Tank (Specify Requirements) ��a�_--Q'� !-®'� ' �l <br /> Disposal Field {Specify Requirements) --10© L-awa e------------------------------------------------------------------------------I--------------- <br /> ------------------------------------------------ <br /> ------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------- <br /> ----- -------------------------=----------- -------------------------- ---------------------------------------------------------------------------------------------------------------- <br /> J. 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, I shall not employ any person in such manner <br /> CAL Fi4Lcadal�;T "pcto!Vvorkman's Compensati laws of California." <br /> IU 7-4560 or <br /> -'- - ---- <br /> �����/��� <br /> BY ------- -------------------- We--' Title . <br /> -- - ------------------------------------------------------ <br /> (If other than owner), <br /> # OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY f --------------------------- ------------------------------------ DATE ------------------- <br /> BUILDINGPERMIT ISSUED --- --------------------------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS --------- ---------------------------------------------------------------------=------------- <br /> ------------------------------ ------------------ i <br /> ---------------------------------------- ----------------------------------------------------------------------- ---------- ------------------------------------------------------- i <br /> -------------------- ----- ------- - .� <br /> Final Inspection b Date <br /> - ---- --------------------------------------- ---- ------------- --- - - -------- - -- -- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />