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. FOR OFFICE USE: <br /> -.ARPLlCATlON FOR SANITATION PERMIT ' <br /> x <br /> Permit No: <br /> ice- -.- ��.� - ' <br /> `' --------------------- <br /> .� - <br /> {Complete in Triplicate} , <br /> --------------------- <br /> Date Issued __ -_r-�'---- <br /> - <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for apermit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance Na. 549 and existing Rules and Regulations: <br /> JOS ADDRESS/LOCATION -- C ��' CENSUS TRACT ----------------------•- <br /> Owner's Name ----a ? I Phone <br /> �- City ------`------------------------- ----------- <br /> AV` Address --- --- <br /> ----------- ---- --------------------------------------- <br /> _ License # 1--,--- -- -.._ P}ione �-- i <br /> :. Contractor's Name ------ fC =/�Qav 2!�------------- = =' " - I <br /> Installation will serve: Residence-y(Apartment House❑ Commercial-:❑Trailer Court ;❑ <br /> Motel Other ----------------- -- - ---- ------- - <br /> i <br /> ❑ Garbage Grinder . Lot Size / ��'d° -------- <br /> Numb of. living,u'nits:__�------- Number of bedrooms y�'� <br /> Water Su I Public System and name ---------------- ------ - <br /> P Priv <br /> Character of soil to a depth of 3 feet: Sand'[] ' Silt❑ Clay ❑i,� eat❑ Sandy Loom Clay Loam 'D <br /> Hardpan F1 Adobe ❑ Fi11`h+laterial --------- -- If yes,type _----------------------- <br /> { plan,Ian, showing size of lot, location of system in relation-`to wells., buildings, etc. must be placed on reverse side.) <br /> f � - <br /> f NEW INSTALLATION: (No septic tank or seepage pit permitted if Rublic sewer is available within•200 feet,) . <br /> PACKAGE TREATMENT [ ] <br /> SEPTIC TANK' Size - e 0�$ - ---- ------- Liquid Depth t ---------- . <br /> ` � Mdterial_ /7 - -- No. Com rtments <br /> Capacity, � ---- TYpe - <br /> .--- -:=---- <br /> - <br /> r ► i Pro Line __ ' <br /> . Foundation __ <br /> Distance.to.nearest: Well _-- ---+ --------------- p' <br /> - - - filter Materiala �- <br /> "LEACHING LINE .. No. of Lines -=---- g ---.De th F _ _, � <br /> .-_ Len th of each line----._._a!__ gth ../ <br /> = ype Filter Mater�aloj T _ -.� <br /> k.t D Sox T p - _ T — . <br /> p fi _ _ Property Une _ <br /> --Z <br /> ' =6 <' _ " <br /> -Distance to�nearest: Well--:;$_0 Foundation - <br /> I f <br /> / 6amete �a -umber .---, -- <br /> Rack Filled Yes No i❑ <br /> SEEPAGE PIT 4 :), Depth ` <br /> Water.7a6�1e Depth ------ ----------------- Rock Size 1__` i <br /> `.1, �� _ = �ndation�. s' Prop. Line ..__ . <br /> �- Distance to nearest: W611F- .._ - ='~'-- = - <br /> Fo <br /> 'j,, Date ) <br /> I <br /> REPAIR/ADDITION(Prev.,So'n4ation Permit# <br /> ` T i n ----- ------- ------- <br /> Septic Tank lank (Specify Require tints) --=----------------�- -'----------------------------------- - ----- "----- -- <br /> I Disposal .Field,(Specify;Requirements)4------------F------ <br /> �_:p� -' <br /> s <br /> - <br /> T---.; ---- . - -------- - ------- ----------- <br /> - <br /> -=----=--•--- ------------ --------- - --- - ,- <br /> -------------------- ---- ------------------------------------------ <br /> ------ ------ - --- ---------- -------------------------i K = <br /> i f{Draw existi6d.19nd required additio!5� re <br /> on verseside).­__­ <br /> .�, <br /> re pared this application and.'that-the work will be done in accordance � <br /> I herebycertify, that I have p p with San .lonquin <br /> t �, <br /> Count Ordinances, State'Laws, and' Rules and Regulations of the`�rjn.3oac-vin Local Health Drstrict. Home owner or Hcen-� <br /> County, q a 5 <br /> sed agents signature certifies the following: € t i ' <br /> "I certify that in the performance of the work fo-r which this permit s issbed,.I shall, not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California.'.. �Q, �A! <br /> r ,Owner <br /> Signed ------ <br /> -- } <br /> ii ! r:.Title --_--- � - -- '"--�-�_ - ---i---------------- <br /> SY <br /> --------- -- ----------- - --- <br /> . .(1 er than owned <br /> rF <br /> FOO DEP,ARTMENT SE ONLY <br /> { APPLICATION ACCEPTED,BYE._ I ' - - 1- �- DATE .. - //- <br /> . i <br /> --- '' <br /> ' ---------------------------- - -----DATE--------------•'-------------------------•--• <br /> BUILDING PERMIT ISSUED ------. - -_ _ ---- '_ --=--- - ---.' -- --------=--------- <br /> ADDITIONAL COMMENTS __.> -- ---'-'-------------------------•------- - r <br /> M - <br /> ------------f --- -------- ----------- <br /> --------------------------------------------------------- --------------------- <br /> -------- <br /> +-.-i -------- <br /> . n --------- <br /> ------------ <br /> ---- <br /> l_.____..___________ - ___________ <br /> 1 <br /> __ ______ _________________ ______________________________________..____.___._._____.___________-______._______________________ a <br /> Final Inspection b r . ------------------------------------------------------------ <br /> SAN <br /> - ------------------------------------- Date <br /> SAN JOAQUIN LOCAL HEALTH TRICT <br /> �.,� � � .;4 ,."'"'-Y•N . � '. ,� -. tom:''--�., } � ,� <br /> H. 9 1 ',68 Rev. 5M - <br />