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FOR OFFICE,USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> /(I(/Permit No. ......3`_ ....... <br /> ... (Com.plete in Triplicate) <br /> r <br />......................................................... Date Issued ....... <br />--•------ ............................ <br /> This Permit Expires 1 Year From Date Issued <br /> A lication 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 /> r <br />' — .-f - CENSUS TRACT .............. ......... <br /> JOB ADDRESS/LOCATION ...:..171-L L.....-:�.- .-.-. _ lv.. .- • ................ <br /> r '-1.. .Phone .................................... <br /> Owner's Name ........_..°'• ••�• ......- 1 CJ ......_... <br /> f �..... .,. F ...................... <br /> . 3. ............ City .--.,�- G1? — :... <br /> Address --.- ; <br /> R .............. <br /> Contractor's Name ..(`��- h+. �f�:� . .-.. :.................... ry.... i.icense # .........,... Phone <br /> i �, <!` � <br /> Installation Will serve: Residence-❑'Apartment House❑Commercial [:]Trailer Court <br /> i❑ Other ..--....--• t............................. <br /> Motel's ' <br /> - C T....... <br /> Number of living unttst.,..l...... plumber of bedrooms ...!!Garbage Grinder Lot Size .. fg--•f <br /> k . Private �' "= <br /> Water Supply. Public System and name .-_..ii.................... <br /> Character of soil to a depth of 3 feet: Sand❑ Silt E] Cloy ❑ Peat El Sandy Loam 0 -Clay Loam <br /> p Ylt © If yes,type ----------------­------- <br /> -� - - Hard an 5 Adobe ❑'} II Material <br /> ' buildings, etc. must be placed on reverse side.) <br /> (Plot plan, showing size of lot, location of.-eystem in relation oto wells, <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted If ublic sewer is available within 240 feet,) �� NJ <br /> r t 1C - .. .__.. Liquid Depth ...1..`.��--------------- <br /> -- <br /> PACKAGE TREATMENT { ] SEPTIC TANK .j Size.... ___X.1�J.....---._...... q p Q <br /> Type�� ---- <br /> Capacity <br /> T Vo�. Compartments .... r <br /> . .......... <br /> MaterialCa acit .f <br /> -----.--. tion � Prop. Line ..... - <br /> Distance to nearest ......-----••Founda ` <br /> :._ Len th of each line-.------/�:............ Total Length ...... �........._. <br /> LEACHING LINE �i�No. of Lines •-,`• ' g <br /> , ')I <br /> �_...De Depth Filter--Material <br /> 'D' Box .�`� T �••t- <br /> f Ype Filter hl4aterial�. Qp - , <br /> r �� -. . + ,1���. `.._... Property Line _ ....__. <br /> Distance to nearest: Well _.'� ---- Foundation _.. -. --- •-• - - <br /> De Depth --� -e X Number"�..._..._2- `...... Rock Filled Yes No ❑ <br /> •----- Diameter�--...--�•---•- <br /> SEEPAGE PIT [�%`� P .. -- -. -•_� <br /> fi .Rock Size ..?— ..` - <br /> Water Table Depth -•-•--- --• �` r - <br /> I 1 of >` -a �`:..-- <br /> ` '. Foundation ...��..rt . Prop. Line . <br /> Distance to nearest: Well-. . _: __.... _ # <br /> REPAIR/AUDITION(Prev. Sanitation Perm,it'°# ;- •••• Date,. ..--,- <br /> - T <br /> I €....................................._................. <br /> Septic Tank (Specify Requirements) 1'= ' ..... - - <br /> Disposal Field (Specify Requirements) ------•-- .............................. <br /> .....................•••••..._...... -•---_. <br /> . ... <br /> A----••-------•------•---i----_--- .. ..................... ............ ..........-------------- - I .- -.__.... ..---.....--- -•_----."---.-"""--'-------------------"......._.._-------------------"--•---....-------- ___. ..._-•___....--...,..��. .......... <br /> -�.�. 4 -.-•.. <br /> -. .�. �. {Draw existing and required 3add ifon-on--reverse s1de)`�- <br /> i 1 hereby certify that I have prepared this application and thail 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. Norrie owner or liter. <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 becori.subject to Workman'; Compensation laws of California." <br /> ' <br /> Signed ------------------•..._...... Owner ---...-----••....................... <br /> . <br /> Title ....----- ......--. <br /> BY . ..... ..... ............................ <br /> (If other than owner) <br /> '~ FOR DEPARTMENT USE ONLY ' <br /> __ ....-)•------•��-----•--. DATE ....-�..-.�-..��'...:..�..�.... <br /> APPLICATION ACCEPTED BY ._. DATE ..........:................................ <br /> = r <br /> BUILDING PERMIT ISSUED ----------.-------------------- .................................. ......... <br /> ADDITIONAL COMMENTS t ..:.......... . .........-.............. <br /> ..._ <br /> ...�..�---.................- _. - -- <br /> --......--•_•-•- -_• _ '...•• _--• .... .........�.J• ty ` . ..............•____-....._ 1 1 <br /> Date r .' 1�- .� .. <br /> . ... .. -_ --- . <br /> Final Inspection -�-✓- - T— <br /> _ _ SAN JOAQUIN L CAL HEALTH DISTRICT <br /> r <br /> r <br /> 7/72 <br /> tot <br /> M �w <br />