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• FOR OFFICE USE: � 1 <br /> APPLICATION FOR SANITATION PERMIT <br />...............................•--- ---........:...- Permit No. .7.=��.._/U7 S� <br /> (Complete in Triplicate) <br /> .....•.•.................................. p .�^a 6 7V <br /> .......... . <br /> This Permit Expires 1 Year From Date Issued Date Issued . ... .... <br /> OS'v- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the(work herein t <br /> described, This application ij made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> m <br /> 08 ADDRESS%LOCATION ..UJ S"-t °.:1. �C.t.I.�_G.� .. C11...�.J-�.�Q..S...--.. .-nor.I .CENSUS TRACT _-----_---•---• -:... l <br /> Owner's Name DOtan_ I. .Qlf' Ui.S. -o-.t�e�.�.�c�+-.h.�.r :>�.... ..Pho e T :.T7. ...... <br /> Address .�aG1+n....1��.��Ca-1�.�.... '-F.-,..-...... -----•--. City . '� 14h <br /> Contractor's Name . _..........-- .License # ..- phone ------- ---------------------- <br /> lrsiiillation will serve: Residence*Apartment,House-❑ Commercial [3Trailer Court F] <br /> Motel ❑Other ....... --------- ---------------- <br /> Number of living units:.. ... Number of be <br /> ...3....Garbage Grinder' ...-Lot Size - ---x.- <br /> �.}. t I Private" . <br /> Water Supply: Public System and name pri.o.Gt.l.t.. ................ .. ._.......... ---.........--- <br /> Character of soil to a depth of 3 feet: Sand'❑ `Silt-0 Clay E] Peat❑ Sandy Loam d: Clay Loam ❑ <br /> j <br /> Hardpan ❑ Adobe Fill Material --... ..:-:. If yes, type ............................ <br /> (Plot plan, showing size of fot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) r <br /> NEW INSTALLATION: (No septic tank or kseepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ SEPTIC TANKi: S_ ize....1- a..'. A,L�:................... Liquid Depth ...... i <br /> Capacity .. Type . ..._.I—— Material.-.---.. .... ....•-.. No. Compartments ..................... <br /> Distance to nearest: WeILWQ�t�o '-- - .�-_...Foundat/on ..�.o ........ Prop. Line -- g- <br /> LEACHING LINE ] No. of Lines -.. _ Length of each line.....�.5"........ ...... Toto <br /> l Length ...1."f _.............__. <br /> D' Bax �' Type Filter Material --------------------Depth Filter Materia! ........---•---.-......... --•---•----••_- <br /> Distance to nearest: Well 1. Q.r. --------- Foundation . ... . ---------..K. Property Line ....... <br /> SEEPAGE PIT [ ] Depth ------ Diameter .. -.. Number - Rock Filled Yes No <br /> Water Table Depth Rock Size ......... ..........."------ <br /> i Distance to nearest: Well .•---------------------------------------Foundation ...........:........ Prop. Line. ................ <br />` REPAIR/ADDITION(Prev.:•Sanita#ion Permit# -------- -----_------- ""--- --- Date ---.----..-"------•-•------------- t <br /> - .......- r "---------- ----•---•-•. ...................:.. .........._.-------------- <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements[ ------------- ------ ....... - ......... ............--- <br /> i <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. Horne 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 /> as to be me subject to Wo an's Compensation laws of California." <br /> Signed=Va,4c�r���1 �,�.... ... ��.. . . .�..............•---•-- <br /> ------•---- --------- Owner <br /> BY ............... " ............................... ------ .................. Title ... ................... ....... .. ----....---........ --- <br /> (if other than owner) <br /> FOR DEPART SE O Y <br /> APPLICATION ACCEPTED BY . ..... r�...... .... r --_. DATE .�/,. o -677.Y/............. <br /> BUILDING PERMIT ISSUED .-.....-_......._ _•--- ----------------------------- •-----_ ----- ---•- DATE <br /> ADDITIONAL COMMENTS -------------------- ............... - .. ----- <br /> ................................................•--------- • ----..-------- ....- <br /> Final Inspection by: . -------------------- ------ �!-.!.Date ._Jo y ...:_..........-- <br /> r SAN JOAQUIN LOCAL HEALTH Mal? . . K <br /> �.° - <br /> 7/723 ,1.4 <br />