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FOR OFFICE'USE: APPLICATION FOR SANITATION PERMIT <br /> -- --- --- ----------- ------------------------------ Permit No. <br /> (Complete in Triplicate) <br /> This hermit Expires 1 Year From Date Issued <br /> Date Issued <br /> _ _ _ __ _ .3'3'7S <br /> ----------------------------• -- ---- -_- -- ----- <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 /> 280' CKTHOOP P-A <br /> JOB ADDRESS/LOCATION . ---------------------------------------------------- ---------------------------------CENSUS TRACT --------------•--------- <br /> Owner's Name <br /> -A-(Z------- O.S_Boll'A/ ------------------------------------Phone 968- 6-1 y8 <br /> Address -...... � , Jy key City --- M -------------------------------------------- <br /> 5 ; -1- <br /> Contractor's Name - -- ---.- ---'P-------------------------------------.License # 2Y�*8------ Phone ._81.3'66 K---- <br /> Installation will serve: Residence ❑ Apartment House,❑ Commercial ❑Trailer Court l❑ <br /> Motel ❑ Other ----D UPltX -------------------- <br /> _ _ <br /> ?_____Garbage Grinder ----.____.__ Lot Size __ - CltcS- ___ ______---- <br /> Number of living units:_._----- Number of bedrooms <br /> Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'[Z Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam .E] <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If 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 tankIK <br /> epage pit ermitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TA ] Size------------------ ----------------- -------- <br /> Liquid Depth -----------_---------.----- <br /> Capacity ---------- -- Type -------------------- Materi --------------------- Compartments ------- -•------- .... 00 <br /> oC} <br /> Distance to neWel -:--------------------------- ___:__Foundation _ _---_-_ __________ Prop. Line -------------------.... U <br /> LEACHING LINE [ ] No. of Lines -- ------ -____(Length of ea line---------------- --- ------ Total Length _______----.-__ ------------ -J J <br /> 'D' Box ----------- ilter Material ----- --------------Depth ter Material -------------_---------------------.--------- X <br /> Distance to nearell ________________--_ -_ Foundation _ _____-___________ Property Line -----------------_......'� <br />` SEEPAGE PIT [ ] Depth ------------- Diameter _--____ _______ Number _. __._-_----______._____ Rock Filled Yes ❑ 'NoWater Table D ---------------------- -- ----------------- -Rock SizeDistance to neaell ----------------------------------------Foundation -.------------------- Prop. Line .-------------------- <br /> REPAIR ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __-________________...:----------I <br /> isTank (Specify Requirements) -------------------------------------------------------------- ---------------------------------------------------------------------------- <br /> Disposal Field (Specify Requirements) ---AAp IR O f g T11V6 Sy—7J`n---------- , <br /> ,a <br /> ---------'------------------------ - <br /> ---------- <br /> * ---- --------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <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 beasubjeto W kman's Comption laws of California." <br /> Signed ---- - - -- --- ---------- -- --- --- -------------------------------- Owner <br /> BY ---------------- ----- Title <br /> (If other than owner] _ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - - ---------------------------------------------------------------------------. DATE ------- '.a - $------ <br /> ' BUILDING PERMIT ISSUED ----- ------------------------------------------------------------------------------------------------DATE <br /> -------------------------------------------- <br /> ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------------------------- ---------------- ----------•---------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•. <br /> --------------------------------------------- ----------------------------------------------------------------------------------------------------- <br /> ----------------------------------- <br /> ` ----' ---------------- - --- - , <br /> -------------------------------------------------------------------------------- --------- - - -- <br /> I Final Inspection by: ---------- -- -----------------.Date -------------------------- <br /> SAN <br /> ------- �`�------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 4 E. H. 9 1-'68 Rev. 5M <br />