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FOR!OFFICE USE.- <br /> ...... .............. <br /> SE: +� FOR SANITATION PERMIT <br /> �- . APPLICATIONPermit Na. 7fi%_�aY <br />�...,.._...-- I� ......... 11' (Complete in Triplicate) <br /> �1 ................ This Permit Expires I Year From Date Issued Date Issued .. !. . ........... <br /> IM <br /> Application is hereby trade to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> i describ I"d. This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: <br /> F <br /> JOB ADDRESS/LOCATION ZVV' + 6.-•••-R..P-_t.�r!0L 'CENSUS TRACT ............... <br /> Owner' � Name . .. ! .. .._ _cSJ. L_. �/!A►. _M .........................Phone. .��. `��'<, ....... <br /> Address / .V.L1....../V/.*`PV e._k0-P•.............� .._...r�Ctity�'.�"rl2�c /. . <br /> i it I` - n Phone d <br /> Contractor's Name-.--,,, <br /> -, r-l...-{,r- � . Lice se'#�/. <br /> Installation will serve: Residence ❑ Apartment House-[] Commercial :❑Trailer Court 0 <br /> Motel ❑Other .......................:.......... ...... .4 <br /> Numbei of li.vingTunits:.. v.,-Nu .ber-of.bedroo ms.3. ......Garbage,Grinder..............Lot Size-., ............. ........ Q <br /> Water Su pply.. Public SystemM and name ............................• ---.....------.......... _...... Private <br /> Character of sail to a depth of 3 feet: Sand❑ Silt E3Clay C] ' Peat ElSandy loam C) Clay Loom C] <br /> j,7—�9&_rdponEj_A_8_obeX Fill Material ............ If yes,type _.__----- �} <br /> (Plot plan, showing size 0410t, ion 10t, system in relation to wells,buildings, etc: must be placed on reverse side.1 <br /> NEW INSTALLATION: (NJseptic tank or seepage pit permitted if public sewe is ov�aililab;e within 204 feet,}� <br /> r .: _ ------- LiquidSEPTIC TANK Compartments--------- <br /> cc, _ • :. ...... <br /> Distance to nearest Well""" :J:--•---•- �" G_`... . p. /-�—• <br /> z '��....--:."Foundation .._Pro Line ......... <br /> i <br /> LEACHI G LINE [ ) Na. of Lines . -- -----..''4 Lengtkt oaf each line..---r :l3___. -....... Total Length' ..Z�. .::O--------.• � <br /> V'+/ <br /> F <br /> D' <br /> ox--3-.-_-Type Filter Material p1_ nZ. epih Filter Material <br /> c/ 5 .......... <br /> ... <br /> Distance' to•nearest: Well � .............Foun'dafiion. "#...----•----••---- PropertyLine 2z>................. <br /> �. <br /> Or <br /> SEEPAGE PIT ( I Depth ................. .. Diameter ______......... Number :�T.:.-.:.:- L:... •Rock rF.filled. Yes (] No <br /> ti t <br /> Wa er Table Depth . �, Rock s ie ........................... `. <br /> ..............I...... �_. ...... <br /> Distance to nearest: Well ...........:............................F Foundation .-..---------.-... Prop. Line� ..........ill _•----.1,� <br /> o _. P <br /> REPAIRADDITION(Prev. Sanitation Permit�# .--•-----------------•._.--••-•---- --------- Date ........................ --------- <br /> Septi' Tank (Specify Requirements) ......... _---_-;._-s:.----=-------.................................•--..............-......--•--•• } <br /> s <br /> Disposal Field {Specify Requrementsl ..................... ...-........... § = <br /> .-S <br /> 4 r <br /> y <br /> ;gyp �.,�N .....................�_..... . . - <br /> ....._�. ................................................................. <br /> ...........•--•-.......--•-•---.. ..... . ...... <br /> prepared(Draw existting and required addition on reverse side) p ' <br /> I hereby certify <br /> that I have this application and that the,work will be done in accordance with San Joaquin <br /> t County;Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health 'District. Home owner or licen. <br /> t sed agents signature certifies the following:' <br /> "I certify that in the performance of the'work for which this permit is,issued, 1 shall not employ any person in such mannan <br /> as to become subject t ql an's Compensation laws-of-California." <br /> Signed..........a- ...!. ��� .. .......- <br /> -_.�-- Owner <br /> ByTitle ................................ <br /> (if other than I'owner) <br /> I3� , FOR DEPARTMENT USE ONLY i <br /> APPC6T1ON ACCEPTED BY ..... I ! . DATE .. ".1...: _ <br /> BUILDINGPERMIT ISSUED !L-------------------•-- ...............------•-- �.....:• � ._............--•--'•---DATE ----....................................... <br /> ADDITIONAL COMMENTS 'I Z`` " x ` <br /> •-- -.•� ---•..............................f:...-.-._........_._.........._......_............--... <br /> is ii •--•----...I...... •...... ----------------- <br /> k :::: : :::::::::::::::.:::::: _ :-- -----Y- ...... --•...~.�. .................................. <br /> ...--......-- ... .....----�:....�..........=_.-:....-....... ... .................. 1 <br /> ..-...--.A..... ...----•-..•-•••... .� :.. �::.........: . . ....................................................................•--• -- .---•- <br /> Final inspection by: ..Date � ...� ...' ................ <br /> SAN JOAQUIN �LOCAL HEALTH DISTRICT <br /> 7172 3 X <br />