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•:.+ _ ,�, �� ':,.;,„tom j`i :,- � st �+J r� �d t4�. <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT �3 <br /> (Complete i npl'cate�"--" i <br /> --------------------------------------------------------- <br /> This Permit Expires ] Year From date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh 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: I <br /> JOB ADDRESSAOC ION . _ ._ p__-- -,-...rrt?�1�r(� u-- T�......................CENSUS TRACT -------------------------- <br /> Owner's Name Pho <br /> 2-41 <br /> Address !- ��' �;. --- - -•--. City <br /> .�.., - } <br /> - <br /> / = License # :. ---- Phone i <br /> —•�'t�� <br /> Contractor's Name .- ----- `�-'----�-� - -- -----�! - - - - 661 -'k t _..--••---------- <br /> Installation will serve: Residence ❑ Apartment'-Hous e'❑ Comme tial,:❑Trailer Court ;❑ <br /> Motel ❑Other <br /> Number of living units:----- _____ Number of rooms _____-I...Gorbcge Grinder ............ Lot Siie -_ _______________________ <br /> - - k <br /> Water Supply: Public System and name - - ---- ----------------------------------------------------------------•• --- ; Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'Q Silt❑ Clay ❑ Peat❑ Sandy Loa m�lay Loam.0 4 <br /> �..-,.-...x-. <br /> Hardpan ❑ Adobe '❑ Fill Material .--.€------ 1f 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 tank or seepage pit permitted if public sewer is available within 260 feet,} V <br /> f <br /> PACKAGE TREATMENT [ 7 SEPTIC TANK[ ] Size_____7 '_ _.--- -------- Liquid Depth - ______________ 1.4 F <br /> Capacity __/�Q_____ Type ___ Material__ � _ _ . No. Compartments _-__"Z_._.__.-_- e <br /> 1r1 t''. <br /> Distance to nearest: Well ____ ��_-------------[_______Foundation __/Q_�''______ Pro'Aine ,",�,______ <br /> 01 <br /> LEACHING LINE [ ] No. of Lines ._ ------.-- --- Length of each, line--___! �S1 alp Length _ -. <br /> .r <br /> D' Box .___ _ Type Filter Material -_ :Depth Filter Material --------------------- <br /> Distance to nearest: Well _-__ Foundation JA.�t--._____.__ Property¢,;L�ine ___, f'___........ <br /> SEEPAGE PIT [ ] Depth ________________ ___ Diameter _____________-__ Number ----__.__.--__-.____-_._- Rock Filled ,Yes (] No C] <br /> Water Table Depth ------------- Size ---------------__ -1--le � <br /> A ' . <br /> 1 Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----._-----.--_.------ <br /> REPAIRfAbD1T10N.(Prey.-Sanitation Permit__#_-------__-------------------------------------- Date _____-____________________________j ! <br /> Septic,Tank (Specify Requirements)l-------------------- ----- --------1=--=--'-------------------------------------- - --------------------------- <br /> - <br /> Disposal Field (Specify Requirement's)J`_---__-_________ _ _ _ _----------------- _ <br /> j , ! - - - ----------------------------------- <br /> ".,,�. <br /> I -- ------------ --- "--- "`° - f. <br /> ' `-------!n--------------------------- - -------- <br /> _ (Draw existindand required addition on reverse side) <br /> I hereby certify#hat I"Piave prepared this application and that the work will be done in accordance with San Joaquin A <br /> County Ordinanc"es;-State}Laws„:arid Rufes:and,Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents-signature certifies4he following:- cl-1;1� <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 become subject to Workman's Compensation laws of California.” <br /> Signed --------------------------- = - = ----------------------------------------------- Owner 1 <br /> BY --------------- <br /> - <br /> -- _ - - =----------=------------------ - - ------------ - Title -' - <br /> (If other than owner.) '� ' `4 <br /> f FOR DEPARTMENT USE ONLY °`1 ' <br /> APPLICATION ACCEPTED,BY _._ ___ -__- t -`_- ---- <br /> -- - - - --------------------- ---- - -- -- --- ---------' DATE -.�_-"��_Z�'r-�-------- <br /> BUILDING <br /> ---- � -- <br /> BUILDIPdG PERMIT, ISSUED . ----- DATE x {---------------- <br /> ADDITIONALCOMMENTS -----------------------------------•-------------------••------------------------------------------------------------------------------------.---- /--------- <br /> 1 ----------- ---------- `------------------------------------------------------------ ------------- <br /> t <br /> --------- ------------------------------------------------------- -------------------------------------------- ------------------------------------------------------------------ --- <br /> ----------------------_ <br /> ------------------- - - - - ------------------------------------------------------------------------- _ <br /> 7 <br /> Final Inspection by: --- �:-------------------------------Date - /�►� ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68'Rev M1t-'8�J <br />