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FOIL OFFICE USE:". APPLICATION FOR SANITATION PERMIT <br /> %' tl J{ <br /> I a Permit No. =-- <br /> i --------------- (Complete in Triplicate) <br /> --- ------------- --------------,.._ :-----:-:-- € Date Issued -�_2/�-/ <br /> i <br /> --- -- -- <br /> This Permit Expires 1 Year From Date,lssued <br /> -------------------- <br /> ------ <br /> Application is herebymade to the San Joaquin Local Health District fora .pe it to construct and install the work herein <br /> described. This application ation is made in compliance with County Ordinance No 549 and existing Rules and Regulations. <br /> �/ �„ i /' -------------CENSUS TRACT -------- - _---- <br /> - <br /> ADDRESS/LOCATION ._ -zy x----- -- JA7 �---- / ----- --- <br /> Owner's Name - P'- ---------- XU1-/�-Z-------------- -------- ._Phoner0�_3_'._�P C�� <br /> ---- <br /> .�' city° ryy'�--------------•-------------- ----------- <br /> Address __.._ __ " � / <br /> Name 1_7Z License � � Phone -------------------- <br /> Contractor's <br /> � II. <br /> 44 <br /> Installation will serve: Residence ( artment House❑ Commerciale;:❑Trailer Court ❑ <br /> Motel ❑Other ----- --- -- j f. <br /> w.x1. <br /> Numb-er of living units:-�_� -""Number of'bedrooms' -�`-Garbage-•Grinder-.�'--__- Lot-Size _ ____-_____- �'-----'-�� <br /> ' Water Supply: Public System and name ------------------------------------ -- Private <br /> l -- <br /> ► F € <br /> Character of soil to a depth of 3 feet: Sand''Silt❑ Clay ❑ Pea# ❑ Sandy Loam .[I Clay loam.E] <br /> .. _� <br /> � Hardpan ❑�Y•Adobe=❑ "Fill Materiai•_� ____Jf yes type _ ---------1' _----------- <br /> , <br /> (Phot plan, showing size of lot, location of system in relation-to wells, buildings, .etc, must}be placed on reverse side.) <br /> t �/ 1 ' O <br /> { r vailabll.within 200 feet] �� <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if�publ�sew r ��'� � V <br /> f, Liquid Depth _ 4 ------- <br /> PACKAGE TREATMENT, <br /> ------------- <br /> [ I SEPTIC TANK![4- ,' <br /> Size-�_ ___________�. - q P <br /> ' Capacity!., - --; 'Tvp = TMaterialf.No. Compartments................. <br /> -. <br /> �J s <br /> t, �- -- _ -- Pro Line <br /> Distance:,to,, nearest: Well _I��-----------��---E��oundati fn�; __ -- - - - --- p• s �, <br /> € tom , F <br /> "` -� / - Total Len th _ <br /> _ . LEACHING LINE [�No. of Lines �_,_______________ _____ Length of each line__ __� _ - g <br /> D' Box - Type Filter Material s+�Q��__:t_�Depth, Fdler Material _ _°_-------------------•---.--------- <br /> Ie <br /> Distance-tb nearest: Well _9?c)--------------- Foundation w---------------- Property Line ---_____--_----.-..--•-- <br /> SEEPAGE PIT Depth/! ------- Diameter --------------- Number -- ------ <br /> --- - ' <br /> ____ Rock Filled Yes ❑ No 0 <br /> 5 s,'-b 1-10.'- Ize --------------------- <br /> '' Water' Table Depth <br /> P <br /> pitance to nearest: Well ---------- -- --------------=--------Foundation ---------------.---- Pro `Line -----------_----• <br /> ,� 1< <br /> REPAIR/ADDITION(Prev.�Sanitation Permit# -------------'`�------------------;" -- Date ------ `--'-----------•----------1 ; <br /> ptic Tank (Specify`•�Requirerz�ents).-•=•.-•---- --------------------------------------------------- <br /> -------- ------------�--• ---------'------ -----�-------- -�-----=----------------------------,•---------•------------------ <br /> JJJ IES F <br /> ,'Disposal Field (Specify Requirements) _____-_-- <br /> kkJ --------------------•----------1---- k <br /> 1 ) i T. t> ' --- S i kEE ______________ <br /> 8._� E -.. _._ --______'___ �--_'F-S-------------------------------------------------------------- <br /> r — <br /> ,. �. (Draw existing and required addition on rah verse side)tl <br /> I hereby ce,Yt1fy;that I have prepared this application and that the work will be done din accordance with San Joaquin <br /> County Ordinances, State Laws 4;and Rules and Regulations of the San Joagiul Local H blth District. Home owner or licen- <br /> sed agents signpture certifies the following: ` <br /> "I certify that in the performance of•the work for which this permit is issued shall no a ploy any person in such manner <br /> as to become subject�ta Workman's Compensation laws,of-California." i <br /> Signed Owner <br /> r - ✓. 4 Title . _f�liw �'/.� -- <br /> I BY = -------- © _ <br /> x <br /> i (If other than owner <br /> 4 ( <br /> {E ,' Y <br /> OR DEPARTMENT USE <br /> APPLICATION ACCEPTED BY -__, ---- --------------------------- I_____-- __-----. DATE __-- --�" <br /> - -- <br /> BUILDING PERMIT ISSUED _:-` =-------------- --------------=------------ ---------------------------------------------------M------------ +3* --DATE = <br /> ADDITIONAL COMMENTS zL--------------- ---------------------------------•----------- --------------- ,; <br /> --------------- <br /> -------------------------- L <br /> ---------------- ____4------------ ---�;-------------------- <br /> y . <br /> ---- - -- --------------- E = <br /> ----------------------------------- <br /> i } <br /> ------------------- f ' <br /> ------- ------------ ------------------------ <br /> Fna! Inspection by: - I.- Date = <br /> s ' < <br /> SANyJOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />