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r <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> z:. ?.. Permit No. ..7_1 <br /> ...".........— <br /> .Y <br /> (Complete In Triplicate) <br /> .......... <br /> .... ...-- ..................................... [S - <br /> ..................................... This Permit Expires I Year From Date Issued <br /> Date Issued ..5�:�S.:7� <br /> 1 fie— 34eo—a('-* <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 ................Xz._1,_.../(7•• 14- •......................CENSUS TRACT .......:.:...::::....:...: <br /> Owner's Name ... ... . ?•,.,/ ., .-.. ..Phone <br /> I Address -------I (ter-rte�. ...............•-••-.. Cit 1Y'N 'pk_x.711-........-•----------•--- ..........a......... <br /> J ; <br /> Contractor's Name .._._. .e:�{�._ r! L. ...............................License #a2 .> --652,. Phone <br /> Installation will serve: Residence VAportment House] Commercial QTrailer Court 0 <br /> 1 --€- Motel-f]Other "...:`.....`...`.......-••••••. � <br /> _._ _._.� <br /> Number of living u�ts:.___ __.___ Number of bedrooms .._3'�....Garbage Grinder .._..._..._. Lot-Size- a ._. _1,3 ..........: d <br /> Water Supply: Public System and no .:..--•--------------•---------•--................................................................. Private <br /> Character of soil to a depth of 3 feet: San Silt❑ Clay ❑ Peat❑ Sandy Loom Q Clay Loam Q <br /> fHardpan 0V Adobe'Q Fill Material ......------ If yes,type --------------t________.--_. r <br /> k 11 j i . f:� <br /> {Plok plan,/showing size of lot, locati /of. system in_relation• #•o_wells,-buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic t7k'or seepage pit permitted If public sewer is available within 200 feet,) <br /> ] SEPTJC ' <br /> PAGiKAG��TREATMENT i( �k ��K� ] Size..-�-X.��`.,y-�----_-•---------------- Liquid Depth ............ <br /> 1 ---Capacit,0.�--a" -...._._ Type Material------ -------------- No. Compartments .. tv <br /> J <br /> j Distance to nearest: Well �a....... .................Foundation ._...._....... Prop.FLine ..-S?....... <br /> -.......... <br /> QCT '�3G� / Total Length 41���`Te�..: �� <br /> LEACHING LINE [ ] No. of lines ...._ ength of each line..___.-4: <br /> i , <br /> D 13ox ..-/...... Type Filter Material --/ .N�...IDeptlt Filter Material ...... '.:........................:... 10 <br /> I + Datan�e to neares�:Well ���:v ..T............ Foundation U...f......... Property YLin�e <br /> .............. <br /> 1 <br /> 3- <br /> SPAGE PIT Depth ................ Diameter ._..._.......... Number ..._.. ...__.•_...•.__._.._ Rock Filled 'Yes (] ,, No C2 <br /> 1 .. <br /> %'Water Table Depth 'tock Size ° 41 <br /> jj �u <br /> Distance to nearest: Well Foundak <br /> tion .......... Pro Line ........................ 4 <br /> REPAIR/ADDITION(Prov-},'Sanitation Permit# ............... ............................ Date .... ............................ t <br /> Septic rank <br /> v (Spes - .........y nts] .. b 4 <br /> ---------........ .. -------- <br /> Disposal Field (Specify Requirements) .....:............................................ ...........................- ............... <br /> I 01 t <br /> R 04 <br /> (Draw.•exisiing and required addition on reverse`�side) ] <br /> I hereby tertifythat;I have prepared this application and that the work will bei done in accordance with,San Joaquin <br /> County-.Ordinances, State: Laws, and Rlas and Regulations of the San Joaquin local Health District. Home owner or iiean- <br /> sed aE <br /> ts signature certifies the following: <br /> "! cethat in the performance of�rhe`rnrork for which this permit is issued, 1 shall not employ any person in such manner <br /> as to' ome subject t' W man's Compensation laws of California." <br /> Signed :._ .. ------------------••-•••--------•-•--•. Owner <br /> sY •• <br /> ................................ :.... ..--•-----......-. ..._.._.. ... <br /> (if other tlion owner) It <br /> y 14; " i FOR-D9PARTMENT USE ONLY i <br /> APPLICATION <br /> iACCEPTEDy . _ - -••-•I-=--•--•-•-------•----------------------------........ DATE.---- <br /> .... <br /> BUILDINGPERMIT ISSUED -••---•-•....................................•-•--.....--•--:.... ------ •••.......-=---......... DATE _..__..._........... ................. <br />' ADDITIONAL COMMENTS ......I. .. .... ------------- <br /> i- -----------------------•--• .............. - - r.......................... ...- ............... <br /> .._._:.._..._.. <br /> •-•----------------•......•---------•••-••'--•-•-•--• :-•-;••--•••--...:......-• --•---..............._....------.........-•-------..........._•_.....--•--.........._..._I....._....... <br />' )....................------ --•..................... . . <br />` Final Inspection by ------ ---------•- -••----••---•-•---- •----- -Date --s✓=-<3.-���f-'.._......--------- <br /> _ SAN,JOAQUIN LOCAL HEALTH DISTRICT <br /> F N 13 24 1_,An ore., nm 7172'--�'M <br />