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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. . �-S�.d. <br /> - rrhis ?ermit Expires 1 Year From Data 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. 549 and existing Rules and,Regulations. <br /> JOB ADDRESS/LOCATION SS�tr5• �'ac:� ToN eD,..•-••,_5�a�kTo0))% .........CENSUS TRACT ....... .........:.... <br /> i . <br /> e <br /> Owner's Nome 4 .....0`4W S••••-••••......................................... Phone <br /> Address .....5. 140.....5:.....roclm_mED--•.........................................'Gwtj+�.....6'Mx-rQrJ-----_CnLk.--•------------...................... <br /> i <br /> Contractor's Name -_Pfl_%Q94.4....-}.._sa!S __________________________________________License # ...... Phone .y6b-RCo7 . <br /> Installation will serve: Residence C]A., oartment House 0 Commerlcial❑Trailer Court 0 <br /> Motel' ther _..ktoei�.�....l:ta^ti .... ......... <br /> Number of living units:__-/....... Number o edrooms ....3......Garbage Grinder ............ Lot Size ....................... <br /> Water Supply: Public System-and.name .........:.............•--•-••••-•-•..._......_......... _........._.. ...................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ _ Silt❑ --Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan Adobe Fill Material...._ ------ if yes, type ---------------------------- <br /> IPlot pian, showing 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,) <br /> PACKAGE TREATMENT [ ] ;SEPTIC TANK f } Size....!. ...?�aA�:....... =-�......... Liquid Depth .... Y..1.'.......-- <br /> �200 ,r, a Maferial_CoNc+2 rE No. Compartments ..... ..... <br /> Capacity --------...��h4.. Type ------- ......... <br /> i fl ' .. Prop. Line 25' <br /> Distance to nearest: Well ____.. F.oundationt..t4.........._. <br /> A <br /> LEACHING LINE [ } No. of Lines .....z....�......... Length of each lin e.------���._.��------- Total length ..__..74.x............... <br /> 'D' Box ..` ... Type Filter Material .-,20c�.....Depth Filter Material <br /> r f <br /> l S' <br /> Distance to nearest: Well ._.. $Q............. Foundation ........................ Property Line ._.25 <br /> �5iy i� t ... I- --•.... Rock Filled Yes [�}— No [j . <br /> SEEPAGE PIT [ ! Depth ........:........... Diameter ._ 3..._...... Number ...--__- -- - <br /> Water Table-Depth <br /> ---------------•--•-----------•-••----- ........Rock Size _.!-11----•-•=Z- -z•------- <br /> Li <br /> I 3^ I t I ' O <br /> Distance to nearest: Well .---._-3.6._Q................ 'Foundation .:.. .......... Prop. Line ..................... <br /> REPAIR/ADDITION(Prev. Sanitation permit# __: ........................................ 6t3te .............i.._...-_....._-_.} <br /> - -- � <br /> Septic Tank (Specify Requirements) .................. ........_............................... .........­.............. ..............-•.......... dl <br /> Disposal Field (Specify Requirements( ------- ----------------•---� �--------•--•----•-•-•-----•--................••----•---•-----...--••----•-••-•--...--•-----•--• s <br /> .............. _....... .............................................. r ............................................................................................................................. <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 /> ,,Icertify,that-in,the performance of the workfor which this permit is issued, I shall not employ any person in such manner <br /> as to beiome subject to Workman's Compensation-laws of Cdliforoia." <br /> Sign ........................ .. Owner a <br /> BY .. • .............................•••------•--••..._... .Title ..FST�:......` ----.. <br /> (lf otfter than ownery <br /> FOR-DEPARTMENT,IISE',ONLY r <br /> APPLICATION ACCEPTED BY..... .___:. <br /> wyC 9 <br /> n -.'r J - - xr'a c DA 1�G. , 3 <br /> BUILDING PERMIT ISSUED ........ .•-----. <br /> DATE - <br /> ADDITIONAL COMMENTS ---------------------- ... ... <br /> I <br /> ........................... <br /> t <br /> ............................•--...... ....................... .. :...:.... i 4 <br /> ..... ... . <br /> ........................... ... . ... <br /> Final Inspection by. ....... ....... ..••- ........Date .. - .... <br /> L HEALTH ISIS ° <br /> JOAQUI <br /> HEA <br /> LOCAp T DISTRICT' " <br /> � ',`�p �.:' ��p �M YFd(f ��: y .'� �KY�' n� �- t a �./i�f SCJ 1]�'. 1.A':; � v, a • � 4 <br /> r u 13'•24,'°.�e r,_=..-.:�i� _. '� '� <��a.�k�r'6*.�,' •, . .�-'.. _ .. r'a ,..a 't� s{ `�I�� � sr � � <br />