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FOR OFFICE USE: APPLICATION FOR SANITATION _PERMIT <br /> Permit No: 3— 1,37 <br /> ---- -- ------------------------- ---------------------- (Complete in Triplicate) <br /> ---- --��------ - - Dclte Issued --- -----i----- <br /> This PeS�nit;Expir_s 1 <br /> ---- --------- ----------------------------------- <br /> a(ear,F'rom Da£e:lssu+ <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 Rule and Regulations. <br /> ` �7 -r---,4T -CENSUS`TRACT <br /> -------------------------- <br /> JOB ADDRESS/LOCATION"----."�;� dt7=_I<"��-------T=='"� = = = "- `" <br /> Owner's Name L <br /> _ <br /> ----------Phone - <br /> ]E� 5---- L --lam <br /> City 'f1s42.1 <br /> "------ L?--------- ,�l,�' = - ------ <br /> Address � --------v� -- - -- _ G 6 <br /> License #c -2'_-_0a_-_ Phone 0?3_ <br /> Co ntract 6r's Name -- ':_1'_�l€ ------------------------------ I <br /> Installation will serve: Residence-KApartment House^❑ Commercial:❑Trailer Court l❑ <br /> f <br /> Motel ❑ Other -------------------------------------------- , <br /> I - 1---------- <br /> N:umber of living units:.,_-f__.__ Number of bedrooms •__Garbage Grinder __________._ Lot Size ___ __________________________� <br /> Water Supply: Public System and name ____-______----- -- -------------------------- --------Private <br /> I p Peat ❑ Sand Loam Clay Loam ❑ <br /> Character'of soil to a de th of 3 feet: Sand'❑ Silt❑ Clay ❑ Y { <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------"----------------- <br /> a I <br /> IRI'ot plan, showing size of lot, location of system in relation to-wells, buildings; etc: must be pla ed on reverse side.) <br /> I <br /> INSTALLATION: (No septic tank or seepage pit permittedf=pylic sewer is available within 200 feefi,) <br /> - --`_ . <br /> SEPTIC TANKS� ` Size-------- -- ---------------------------------- <br /> Capacity <br /> - ---- ------------------- Liquid f?epth ---------- <br /> PA', <br /> �.� <br /> PACKAGE TREATMENT [ � L ] - - - --" } <br /> T e Material No. Compartments ----------- •-•-------S <br /> Capacity --------------- -- Yp <br /> Distance to nearest: Well ----------------=-------------------Foundation ------------------ --- Prop. Line ----------------------� <br /> LEACHING LINE I ] No. of Lines - ------ Length of each line-------- ------------------- Total Length _____------- <br /> 'D' Box ----- Type Filter Material -------------------Depth Filter,. Material --------------- ----------------- ... .. <br /> Proper Line- ------------ ' <br /> Distance to nearest: Well ______________ --_ Foundation - i <br /> SEEPAGE PIT [ ] Depth ---- Diameter ---------- ----- Number ---------------------------- Rock Filled Yes El No <br /> Water Table Depth -- ----- -Rock Size ------------------------------ t` O <br /> f <br /> Distance to nearest: Well _____________________ <br /> f=oundation --------------- Prap. ` e -k------... <br /> - �=k 1`. . <br /> I <br /> REPAIR)ADQITION(Prev. Sanitation Perm #a;�=--------------- -------=---------------- ate ---------------------------- <br /> ------ <br /> k s.` <br /> Septic ank (Specify Requirementsl�- ------- <br /> f <br /> Disposa I Field (Specify Requirements] - j <br /> ---- ---------------------------------------- --------------- I-- <br /> = ------------------------ --------- ------------------ ------ <br /> t <br /> (Draw existingand required adds#ion�oriir��erse sides <br /> F p""_p pp be done -r�tca�rdance with San Joaquin <br /> t - - <br /> I hereby jcerti that 1 have prepared this a !station and that the work w]l <br /> County Ordinances, State Laws, and Rules and Regulations of the Sam Joaquih Local Health District. ome owner or licen- <br /> sed agents signature certifies the following_ _ � — <br />' "! certify I.that in the performance of the work, Kich this permit isE�ssued, I shall not employ any person in such manner <br /> as tobecome subject to Workman's Compensation lairs of Califrnia. �I <br /> =� owner <br /> a <br /> ' Signed!r--- -------�.f��.....�eya�c�=�/�---------�----•-"--�-t`----•------- ------- O t <br /> I g Title - -------------------�_—` -'7..77771 = <br /> i BY - ------------- --- € > <br /> (Ifo her than owner) <br /> i + 'W11, <br /> f In <br /> j .z Zi <br /> ;r - --- R DE SMENT L1 E +�NLY I - <br /> �, ; € t 1 <br /> APPL1irATFION ACCEPTED BY r �-� ---DATE ._l. <br /> BQILD'I.NG PERMIT', ISSUEDJ_------------------------------ -----=----- ] DATE. t <br /> ADDITIONAL COMMENTS _.°-------------------- -- --------------------------------•----- ----------------------- <br /> - -•----------------------E -------- <br /> -- ---- --'- ' - <br /> ---- ----- --- ----- <br /> --- ---- -.— _--- <br /> ---- ----- - <br /> ---- - ---- ----- -- ---- --- <br /> ------------------------- ------ ------- _ <br /> i ;;_ --- - <br /> ---- -------------------------------------- <br /> -------- - ------- ------------- --- ------=--------- - , <br /> Final Inspection b I-' Date __ __ - --- " <br /> -SAN-JO AQ IN LOCAL HEALTH DIPRICT <br /> E. H. 9 1-'68 Rev. 5M <br />