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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 7 /�351,7 <br /> Permit No: -- -- -------- <br /> F Xomplete in Triplicate) I/ <br /> ------ 7 Y <br /> I Date Issued __` __ ___. <br /> This Permit Expires 1 Year'From Date Issued <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 />' J CENSUS TRACT __------------------------ <br /> Owner's <br /> �_�_�__�_- _. <br /> JOB ADDRESS/LOCATT�ION .__./- j��- 2 gP--:-- - U�rc� _.. ----- <br /> Owner's Name -----1-flC&TFt------1�_A N_P ----------------------------------------------Phone .----------------------------------- <br /> Address ------X1..3 --- ,: ( ----------------------------------- City -----R/& -_------------------------------------------------- <br /> Contractor's Name -- ---- ---------------------------------------------------------License <br /> ----------- ------------------------------.License # ------------------------ Phone ----------------------------- <br /> Installation will serve: Residence [ apartment House❑ Commercial ❑Trailer Court;E] <br /> s Motel F1 Other <br /> ------------------------------------------- <br /> Number of living units:_____ ___.- Number of bedrooms _,?-- ---Garbgge Grinder _. ;....Lott Size ._ -_ c-a A-&----- ----- <br /> Water <br /> ---Water Supply: Public System arld,ncpe— ------ Peat Sand Loam _ Private <br /> Character of soil to a depth of 3 feet: Saeid°[]_Silt:❑ Clay r❑ ❑ yam_ [Clay Loam ❑ V <br /> _ W <br /> Hardpan pi❑ Adobe�]i � Fill Mlateriat If yes, type __` `___ _______________ <br /> i5 <br /> (Plot plan, showing size of lot, locatiori of system in relation to/wells, buildings, etc. must be placed on reverse side.) . <br /> NEW INSTALLATION: (No septic tank or see) age pit permitted/if public sewer is available within 200 feet,] <br /> f PACKAGE TREATMENT [ ] SEPTIC TANK ] Size/---------------------------------------------- Liquid Depth -------------------------- <br /> t CaP/0 cl TYPE I /: Material No. Compartments <br /> r 'to nearest:- Well ----------Z----------------- -----Foundation -- --------------- --- Prop. Line ------------------ <br /> =_771 <br /> ----------------- ... <br /> LEACHING LINE . No? of Lines[ ] l dries Length of each line Total Length <br /> t"' <br /> 'D'; Box - }-.------- Type melte Material --------------------Depth Filter Material --------------------•--_--_------------ -_ r1 <br /> . D'isfance�-tb-nearest: Well _________________i,.Foundation .___________ _ ._______ Property Line <br /> < "1 <br /> SEEPAGE PIT [ � Depth --------------_____ <br /> Dia ter _._ _______.' ` Nurrfl?er _-____.__.______ ---------- Rock Filled Yes ❑ No i❑ <br /> Water Table Depth _______ ------------ <br /> i I �'a <br /> � -------------------------Rock Size - -------------------------- <br /> Distance 10 nearest: Well ' ---------- ------------------------F;oundatio ------------------. Prop. Line --------- ............ <br /> I <br /> -------------------- e -----------------------REPAlR/ADDITION(Prev. 5an�tat�on Permit# ______ _ Dat <br /> Septic Tank (Specify/Requirements) ---------------=--------------------------------------------`- -------------------------------------------<_--------------------------- <br /> Disposal Field (Specify Requirements) ----n --------IF_XIiC-'�/1 �=---- -- -. 7-Et --:-- --•--------------- <br /> 1 <br /> I3 Draw existin •and required addition on reverse side) <br /> I hereby certify that l ave;prepared-this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules an Regulations of the San Joaquin Local Health District. Rome owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify in it perfor ante of,the w` for ich this'permit is issueel�hshall not employ any person in such mannef <br /> P - - r <br /> as to b sub' ct to rkman am satin aws of Califbrn <br /> 9 ----------- .� 3 � <br /> Signed v'Sner 6 i <br /> i BY --- - -------------- --------------------------------------� . - . Title ----------- <br /> T <br /> i (If other than owner) <br /> T � <br /> ;. FOR DEPARTMENT USE ONLY <br /> r � <br /> APPLICATION ACCEPTED BY ........�5- -- -�L�'------------------------ -- ------------------------ ------------------ DATE --- - ---- <br /> BUILDiNG_P_ERM1T ISSUED..-=-_---•---- ------------------------------------------------------------------------- DATE----------------- ----------- <br /> ADDITIONAL COMMENTS ---- ---- ------------------^---------------s- -- - ,<5. . <br /> ' <br /> ---- --- ---`--- - -u-------------,-.-•---- - - ---------------------------- --- --.........----------- - ---- <br /> -- ----------- - <br /> Final Inspec r : ------------------------------Date ---- -- ,. <br /> r/!/*.1 <br /> SAN JOAQUIN LOCAL PZ ALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M C <br />