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— ---� <br /> FOR OFFICE USE: = t' <br /> * _ APPLICATION FOR SANITATION PERMIT permit No. <br /> -- ----------------- --- --------• --------- ----- <br /> (Complete in Triplicate) <br /> ----------------------------------------------------- Date Issued <br /> --------- ------------------------------------- <br /> This Permit Expires I Year From Date issued <br /> an Joaquin Local Health District for a permit to construct and install the work herein <br /> Application ;s hereby made to the SRegulations- <br /> JOB <br /> . <br /> described. This application is made in compliance with County O_rd/finance No. 549 and existing Rules and Reg tions: <br /> JOB ADDRESS/LOCATION,- �-----4�ro_d(_4--- -------- C ------CENSUS TRACT --------- ----•---•------- <br /> / -------Phone ---------------------•---------- <br /> Owner's Name -----------f D_�I.S------- ---�T1��_�.-�-�------------------------------------- <br /> Address -------------zq_q-S0---------F---------kEa o! ------------ City -----FE5C L ------------------ <br /> Contractor s Name ____-1'JwIl>�= -- ------------------------------------------------------•- <br /> ------.License # ----------------------- Phone ------------------------------ <br /> Installation will serve: Residence [Q' artment House�❑ Commercial :❑Trailer Court ',❑ i <br /> Motel ❑ Other ----- -- <br /> -------------- <br /> Number <br /> Number of living units------- __ <br /> ___ Number of bedrooms _7—__ __--.Garbage Grinder jV0- Lot Size --1C1 �� ------------ <br /> ivate <br /> Water Supply: Public System and name _______.____ --- . .-------------- __ <br /> Pr . <br /> Character of soil to a depth of 3 feet: Sand'E3 Silt Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <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 tank or seepage pit permitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT [ I SEPTIC TANK'[ ] Size------------ ----------------------------------- Liquid Depth --------------------------- <br /> �..� w. <br /> Capacity --- - �---- �Ype:\ `, `'--:;.�Material No. Compartments -------------­------ <br />` Distance o 'ne'drint:"Wel! ------------------------------------Foundation _-______-------------- Prop. Line ---•--------- -------- <br /> �1 <br /> LEACHING LINE [ ] - -----------------------• <br /> No. of Lines4 .---: --_---- _.--Length.wof each-line-..,_-:-.--_•-=_-__ -�Tofial=.Lerag t <br /> p' Box ---------- Typ Well <br /> Material p Fil3er' Material -------- -------------------------------- <br /> tarn Foundation/,f Property Line ____________ _________ <br /> .� ---- <br /> SEEPAGE PIT [ ] Depth Diameter ---------------- Numbers._r____. _;_------------------ Rock Filled Yes El No i❑ <br /> ------- ----- <br /> WateriTabl'e Depth -- ----------------------•----- Rock Size- e ---------------------------- -- <br /> Distance to nearest: Well _._.---------------------------------- <br /> Foundation ---------a_-'- '_ ` '+Prop. Line _...--_------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- <br /> Date ------'---------------------------- <br /> --) <br /> Septic Tank (Specify Requirements) ---- --------------- i ---------------- -,------ - ,.. <br /> Disposal Field (Specify Requirements] T1.0 -F --- - -- X g � P r <br /> ---------------------- <br /> I^•ND------QF: 44F&C-H-----i-4 N-�-----PF'_f►---------RQD---rr_Q• A 4— 17Fih _r9 �—' <br /> ----- ------- - --- -------------------- - <br /> - {Draw;existing.azdzregWired;ad�Jit'ion on reverse;si a -0 <br /> r I hereby certify that I have prepared this application and that the work will bet done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Lo L Health District llama owner or licen- <br /> sed agents signature certifies the following: <br /> i "I certify th tin the performan a of the work for which this permit is issued, I:3hall not employ any'°person.in such manner <br /> f-• <br /> as to bac a subfect to. rk n's Com ensati.on laws of California." <br /> p,.� , <br /> z�T; <br /> Signe ............................... <br /> -- ----------- --------- Owner <br /> �. <br /> ---------------------- <br /> t&0------- Title ------------------ ----------------- ----------`------------------- -- <br /> Of other than owner) 1 <br /> FOR DEPARTMENT USE ONLY <br /> f 1 t - ---------- ---------------------------------------------------------' .. DATE __:----.��__:_ `.6— --------- <br /> APPLICATION ACCEPTED BY __-____`fi __ <br /> BUILDING-PERMIT-ISSUED-- __ - -- 77=r77:77:--- <br /> --------------------------" ':.-_w _ __ -- "'___DATE-__- <br /> ADDITIONAL COMMENTS _ - -- -- ' ^::'_ t --=t_` ---- = =_'_ ��------------- --------------- ------------------- <br /> - .-. <br /> -- -- -- --_._------._� a� - _ <br /> -------- - _. - - ---- <br /> i ----------------------------------------- ------------- <br /> - ----- ------ - --- ------ <br /> Finallnspecti Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />