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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / C <br /> Permit No: .Z.11__�VZ <br /> {Complete in Triplicate} <br /> ---------------------------------------------------- <br /> Dcite Ensued <br /> ---_--_-------------------------- _ This Permit_Expires 1_Year-From Dpfe.lssued <br /> 3 <br /> "`Applicationis`lier�eby"made"t`o rhe"San Joaquin'L'Oca!'Hedlth District fora permit to-construct and •inhal the-work-herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and'Regujations: <br /> I !I. <br /> JOB=AIDZESS/LOCATION ---- ----RD-------------------CENSUS TRACT _---� i.._.._____-- ` <br /> O ! -- ---- f SC- -L <br /> Ow ns Name .�.EY1-IT1:�----BRaS_ � � � - -- - -- - ----- ----------•�-��------- <br /> fl.t_R - _rT - ' <br /> Phone._ _ <br /> GQ7RF ► CrYn_� -----•------ <br /> __-Addy 55 1_ q -------------- ------------ ----- ori <br /> Contractor's Name ___QA}'i_Dh_L ---CON_�R � - ___ _1-p _- License # :__ -- --_ Phone _ i i <br /> P v _ <br /> Installation will serve: Residence ❑Apartment House,❑ Commercial ❑Trailer Gww4 <br /> t --- <br /> J <br /> t 4 4 <br /> i <br /> Number of livingunits:----- N Mote! F] Other _--_�,_____.____ <br /> { <br /> a e Gander _ -- .�-- Lot Size -- -------- - - - �... <br /> Number of bedrooms _-__.' Garb � <br /> Water Supply: Public System and name ----------------------------- <br /> I <br /> Charat cter of soil to a de th of 3 feet: Sand[] Silt❑ Gay E] Pe��tZ] Sandy�Loam E] Clay,Loam:R9li i <br /> i <br /> P <br /> ' 1 `Hardpan [� Adob {❑- Fill Nlateri I -_ If Yes, tYPe -- <br /> {P1#' s, b <br /> 1plan, showing size of lot, location of system in relation to welluildings, etc: must be placed on reverse side.} <br /> j !'1 <br /> N&'.[NSTALLATION: {No septic tank or seepage pit permitted if publiic`�ewer is available within 200 feet,] # -r"' ~4 <br /> c� ,.� , .. i! LT <br /> PACKAGE TREATMENT [ I SEPTIC TANK' Size._1._�_� �L,_���a___K___��___-__._ Liquid Depth -_-�-/,___r,::_.._,_____ <br /> I <br /> Capacity 12-00 Type - ---__il4Mater <br /> I <br /> P Y � ---- ------------- YP � 1 � � 1't�_�C1R(�J�lo. Compartments --�-�-=---- <br /> `., Distance to nearest. Well --__--- --_-_ 0 : __' ° Foundation I --__----_-_ Prop. Line --5:. `.______ <br /> .�: � is <br /> LE,?ACHING LINE No. of Lines __.___ _--------------- Length of each line__.____ d------------ Total Length - -____g <br /> D' Box E�_-- T YP e Filter Material = <br /> - _ _-Depth_.Filter Materia! -------1�--------------!........ <br /> E s . , <br /> Distance to nea est: Well _------- _-__ __��F�oundatiore_;_.-� ------- Property Line _.._ Q__-__:.-_- <br /> SEEPAGE PIT [al__�Depth _.___� 7�_---_--- Diameter r<ym- ___ FNum-ber --_ _/t--------------- Rock Filled Yes F<No 0 <br /> i <br /> ! P -------------------- <br /> } e✓_----_ --------Rock Size ! + <br /> Distance to nearest: Well ---------_-- �1 <br /> Water Table Depth ______._ <br /> ' `-----------------�------Foundation - - -------•---- Prop. Line -----�---=----------- } <br /> . F - F <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _.__---..--- ---��---------------------� Date ________._____.__________________ <br /> .t 1V51- <br /> Septic <br /> y,,,, <br /> Septic Tank {Specify Requirements] ----------------- -------------------------------------``.------------------------------------------------------- ------------- ------------ <br /> ----------------------------- <br /> Dis�po4 a] Field (Specify Requirements) - ll._ . . ._ Y` ------------ .__` <br /> _y---- ------------- rty, <br /> I ! -- _ � !-------------------------------------------------�------- - •--------- <br /> --------------------------------------- <br /> ------------------ ------------------ <br /> --- <br /> ---------------- = _ <br /> ( {Draw e 'sting and required additionfon reverse side , <br /> 1 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 beco u ect to Yforkmos Compe siaton ws of California." i <br /> � E <br /> i <br /> Signed - -- - --------- Q_ . Owner -r <br /> BY --403-44— ------------------- =7-_t- t_RA Title - AR-------------- ---------------------------- ' <br /> r <br /> f other tha owner r <br /> E F011r DEPARTMENT USE ONLY <br /> .APPLICATION ACCEPTED BY -- --- -- ----.. -_.DATE.-------/-D--_.-`. /- - A'r <br /> 1 - <br /> BUILDING­PERM'T-ISSUED`- - <br /> - - --------- ---------- --------------------------------------- <br /> AE ------- - ----•------- <br /> --------- ----- <br /> �[ <br /> U _ S4J C <br /> - <br /> ----- ----------------�- � -_ <br /> - -ADDITIONALMMENTS ` <br /> --- i ---------- - --- ----- - -----_ _ _ <br /> __i---- --------_____ ___ _-__ -------------__ -_ _-----_----- -----_ ----------------------------- <br /> -- <br /> _.--____-.-.-_----.--__---- <br /> — - - <br /> --- ---------------------------------------------------------- <br /> Final Ins econ - ------------------- Date r :-- •------- <br /> t <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M i <br />