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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------- ---------- ---------------------------- Z 3 -3 <br /> {Complete in Triplicate) <br /> Permit No: �___-••------_--. <br /> This Permit Expires i Year From Date Issued - <br /> Date Issued ------------------- 2- <br /> 4 <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 /> JOB ADDRESS/LOCATION ._._ —�_ ,___ ;�.____ ---------------CENSUS TRACT --- _T. - <br /> Owner's Name -------�A-R takI--------- -n-Nt-----.-1 L..I-�-.J-------------------------------------------Phone ------ y- -- ------- <br /> Address .5J S/ Clv� lf _i - <br /> ---------------- - City �-Q <br /> Contractor's Name __- 0W/C--Rl-------------------------------------------------------License # ---------------------- Phone ------------ --------------- <br /> Installation will serve: Residence partment House❑ Commercial ;❑Trailer Court ',❑ <br /> Motel ❑ Other a------------------ ----------- <br /> Number of living �. <br /> units:____- -_---_ Number of bedrooms __�-i~-Garbage Grinder�� -- Lot Size ------------ <br /> I ----------------------------------------- i <br /> Water Supply: Public System and "name - --------M------ ------- •------ ------------------------------------Private' ®— <br /> Character of soil to a depth of 3 feet: Sand']Itod;:Clay E] Peat E] Sandy Loam ❑ Clay Loam <br /> Hardpan Adobe ❑ Fill Material ---NO If yes, type ____________________________ ; <br /> z <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 seepac a pit permitted if public sewer is available within 200 feet,] 3 1j <br /> PACKAGE TREATMENT [ 3 SEPTIC TANK'[ ] Size________________________________________________ Liquid Depth ------- p________ Ij <br /> Capacity - ---------------- Type ----------- -------- Material--------------------- o. Compartments ------ ----- ---:---- . <br /> t <br /> Distance to' nearest: We I ___________________________________Foundation ...... -------------- Prop. Line ------_------..,...... O <br /> [ } ------------ ---- ---- Length of each line__________._________.___ _ Total Length ---------- <br /> LEACHING LINE No. of Lines _•i_� ------------ <br /> _:-----__- <br /> D' Box ------------ Type Fill r Material --------------------Depth Filter Meiteriai _______________-------------'. -----------__ <br /> Qistance to'nearest: Well ________________________ Foundation; ____.______ ____ __.__ Property Line ___._._. _ _� _.. ..._. <br /> SEEPAGE PIT [ ] Depth ------ r___________ Dia ietei ________________ Number __�-------- .__-_____ _____ Rock Filled Yes '[] �No <br /> Water,;Ta ble(Depth `, 3 ------------------------------Rock Siz,A"--'---- ------------------ t <br /> { Distance.fio�n_earest:._W - --------------=---------------Foundation [_ ---c----- Prop. Line ------�---.:-� <br /> t I --•----- <br /> - p <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --- - ----- ----------------#--- -------- Rat --------en ---------------- I a <br /> .Septic Tank (Specify Requirements) ------------------- ----- --------------------=--------------�;-------------;------------------------------_------------k------t-------- <br /> Disposal Field <br /> _ S_ecifR�euirements --- S"� , 2- - --GLN` <br /> y j 'F <br /> cS rt C� a � .- is. <br /> lr (Draw existing and required addition on reverse�iside) E <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: 1 <br /> "I certi Ltiihe perfornce of th rk for hick this permit is issued, 1 shall not employ any person in such manner <br /> as to bei ject to,`W r man's Co n t' ws of California."! r <br /> Signe ----- G ✓1- ----------------- Owner i <br /> By <br /> +��'o-- T - <br /> ' 'Title ----- ------------------------------- ------------------------------ <br /> ----- <br /> (if otherithdn ownerM -� -A 4 <br /> FOR-`DEPARTMENT USE ONLY <br /> = i <br /> APPLICATION ACCEPTED BY _._____._ _ <br /> - --- T. <br /> - <br /> -r a--- —.�--�_ <br /> DATE __---- <br /> — <br /> +.BUILDING PERMIT ISSUED -------------------- ----- -:-------------.. ------------------------_----------DATE <br /> ADDITIONAL COMMENTS -`�F-------- <br /> ------------------ <br /> ------ T ` "=` '�'`' C#t; ' ,'t%'`' <br /> . ,. ----------------------------------------------- <br /> ----- - ---- <br /> - - ,- _ <br /> ---------- --------------------- --- -------- - -- - - ----------------- <br /> ------------------------------------- I �, <br /> -------- ----------------------- --- -------- ------ ------------------------------------------------------------------------------------------=------ <br /> - ------------------------------------------ ------ <br /> -- ( - <br /> Final inspection � - --------------------------- - ---------------- <br /> Date SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br /> E. H. 9 1-'68 Rev. 5M <br />