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FOR OFFICE USE- <br /> APPLICATION FOR SANITATION PERMIT <br /> i ... <br /> / r (Complete In Triplicate) Permit No. ..................... <br /> 7,4 <br /> This Permit Expires 4 Year from Date Issued 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 application is made in compliance with County Ordinance No. 5.49 and.existing.Rules an&-Regulotions: <br /> JOB ADDRESS/LOCATION ------ ��_?....... . ........... .CENSUS TRACT j <br /> Owner's Name .__,._.. --..--- t', G.h. l ............. * i Phone ...:.... .............-- <br /> --•-= <br /> Address ................... : . ,3,$ C�..... �-7.`� City ............. -._..•--•_...... r .......... <br /> -. ... <br /> c�, . . <br /> Contractor's Name _T�-'_. z ca _k_-__.- <br /> -.. License ..._..,� Phone /�. <br /> .Installation will serve: Residence partment House C] Commercial OTraller Court C] <br /> Motel [ Other = <br /> Number of living units:.....JNumber of bodmorns __2......Garbage Grinder j `L. Lot Size � �c--�•--�--- <br /> ,�..---�_.:---• <br /> Water Supply: Public System and ndma �. / <br /> .. . .0 0.----_...._y.......::...:. <br /> Private Q <br /> Character of soil to a depth of 3 feet: Sand Silt CloyPeat X.Sand Loam p Clay Loam L7 <br /> l <br /> Hardpan 0 . Adobe C1,+1fI M6terial/.'Ja9..._ I# es ' <br /> Y ►type <br /> (Plotp lan showing size of lot, loi —st <br /> cation of system in relation to wells, buildings, etc. must be placed on reverse;'side.� <br /> NEW INSTALLATION:' (No <br /> septicItank grjseepage ..it permitted if public sewer is available within 20a#eet;) <br /> PACKAGE TREATMENT { ] SEPTIC TANK Size.. �V ljk's��k ,� ; <br /> ---•-- Liquid Depth ... .......... <br /> Capacity Type Matwial_de. No. Compartments ..... ..-............ <br /> f 11 <br /> f Distance to nearest. Well ------,rl�I, ! .................Foundation ....-__:________...... Prop. Line . <br /> ........:............ <br /> f <br /> LEACHING Wl-o. of lines _____ .......... Length of each line....PS-___ ' Total-.length,-.�. -•-•---•---• , <br /> 'D' Box Y1140..... Type Filter Material __....Depth .Filter Material ..../ .................................. <br /> Distance to nearest: Well __;�t1� -___..... Foundation ....... ... Property Line 1:5�............... <br /> SEEPAGE PIT Depth __,�� _._--... Diameter --- Number <br /> .. ............... Rock Filled Yes V---No 13 <br /> .� <br /> / i" <br /> Water Table Depth--____________ _ f�...................-":=.-Rock Size ...� '.�_... <br /> Distance to nearest: Well ..............Foundation 1 ; Prop. tine <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---•.........-•---................. <br /> } <br /> Septic Tank (Specify Requirements) _ <br /> . <br /> Disposal Field (Specify Requirements) --------------------------- ---•- _ ......----------•--_--_. <br /> ....--• ..._.............._.. .. ....... <br /> -------------------------------------------------- ..................... ------•• --------------------------- ...----••-------------------•••--•-........................... <br /> ..._ <br /> ------------------------------------------------------------------------------- ---------------•......•----------------------------- •- ------------------------ <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,accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Real&District. Home owner or lieew <br /> sed agents signature certifies the following: I <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 laws of California." E <br /> F Signed --------•--:------ <br /> BY ----'----- ------------- <br /> _..... Title -------- -:- -.f <br /> ............ <br /> -.(If the►than owner! ' } <br /> t R PARTMENT USE ONLY I ' <br /> APPLICATION ACCEPTED BY ...... ----------------------•--------- .,. --------- ........... DATE s... j -_...-----''--X <br /> BUILDING PERMIT ISSUED ---- ...... _,-.i .. ------- --•----•-•-----------------------------••--- •---------.---- <br /> ADDITIONAL COMMENTS .._. <br /> ------------ ---------- F <br /> .......................... ...... . __ ----------- _ __ ------ -.________._,_.,. .............................................-.__.__...._. ...___._... <br /> ----•..............�.__.._..__...__ <br /> - <br /> final Inspection b Date4 <br /> Eli .... <br /> 13 2 "6 v• 5MSAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 - 3M <br />