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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> !' 0 77..2.33.. <br /> _._ Y . (Complete In Triplicate) . ...... .. <br /> Permit <br />............................•--•--.....__.............: . _ ' <br /> This Permit expires 1 Year From Date Issued <br /> Date <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. 519 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION <br /> ••--••--••................ <br /> X5'7 7 CENSUS TRACT ._..... •-- <br /> 7 <br /> Owner's Name <br /> [ . Phone. <br /> (.L. <br /> ��++ <br /> Address _....�-�.�7_7...�...J�•Qi�.r►_.r�B--!'1--•-.........................City ...... �.�.�.�._. _ C.}�.....-----•----....---... <br /> Contractor's Name ----e.ec :Gi` 1. --- t .....�. L. ...................License#ca S�.?.?.. Phone --- I <br /> Installation will serve: 11 Residence Apartment House(] Commercial OTrailer Court 0 V I <br /> 1 Motel ❑Other .-•----.......-•--------=--- --- -. ----- Z <br /> Number of living units:_.,.I, Number of bedrooms _......Garbage Grinder ..�... lot Size __.__ 1 , <br /> Water Supply: Public System.and name ........................................................_.......................................... --------Priiv <br /> Character of soil to a depth of 3 feet: Sand p3 Silt 0 Clay ❑ Peat Q Sandy Loam 10 ClayLoam � <br /> Hardpan[ Adobe fl Fill Maternal ..._........ If es,type. ............. .......... # <br /> �ts!(Plot plan, showing size of"lot, location of system in relation tar 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] Size:` _ :1..Q... :.�........................ Liquid Depth ._ ......... a <br /> Capacity 400_....... Material.. r"r----- No. Compartments :................. <br /> i r I+ <br /> Distance to nearest: Well ---d`- ......................Foundation ./.-A........... Prop. line .................._.... <br /> LEACHING LINE No.,of Lines --- ----------------- Length of each line....1.6_0................ Total Length .-10.. <br /> 'D' Box . ---- Type Filter Material .,d.R.......Depth Filter Material PSP&.................................. <br /> Distance to nearest: Well ..e�.0_.-.......... Foundation g-':t------------- Property Line ............... <br /> SEEPAGE PIT [ j Depth -------------------- Diameter ................ Number ............................ Rock Filled Yes ❑ No <br /> Water Table Depth .... .....................................Rock Size ................................ <br /> Distance to nearest: Well -------_--- ..........................founclation ........... ...... Prop. Line ....:-- ....... <br /> REPAIR/ADDITION 1Prev. Sanitation Permit# .........-- ..----•------------------------ Date ...:---.-----.-_-.--....:-------j <br /> 4 <br /> Septic Tank (Specify Requirements) --- •-••----• -----------=••..................................................:........................ ................................ <br /> Disposal Field (Specify Requirementst ------------- - ------•-- --- --•- -- ............... j <br /> -------------------------- -----•-- •---- ............... • ----- <br /> .._..--••----------•--•----••- -•--•-------•---------------_.._...----...............---•---.........._.._.........._...... <br /> s (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquln <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,Disirict. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify t in the performance of the work for which this permit is issued, I shall not employ any person In such manner <br /> k as to l c m subject to Wor rnan' o ens laws of California." <br /> Signed ----- . . ...........................•-•- Owner <br /> By -----------•-------------------•------ •--- ------ Title ---------------- .............._.......................... <br /> ._..._. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. ---- - ..........:...: ....DATE :- - - :.:... <br /> BUILDING PERMIT' ISSUED -r--=-----------------------------------------------------­.­......I........................ .......DATE . •--•--.......__.........------•----- <br /> ADDITIONALCOMMENTS --------------___----------------------------- •--•------•••-•- ------ --•-------------•------...........----------.------------------------...------- <br /> I <br /> --------- ----- -------------• ------•-•-................•.....................•---- ----------------• . ---•---------------- . <br /> r -.._..•--------. --- <br /> p....-.-•_ Y= ` ._.. . •--•-••-• - --------------------------- .........w*cy_..._._....----- ------- ----- <br /> Finai Inspection -- `� .....................Date .2-- ..cp. I................. <br /> I ' EH 13 24 1-65 1-ay. 5M SAN JOAQUIN LOCAL HE.4khFi ISTRICT 874 3M <br />