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FOR OFFICE USEJY6 APPLICATION FOR SANITATION PERMIT <br /> TJ J �� - ��.. Permit No. ✓�' � ' <br /> ----------------- I- --- - (Complete in Tri licate) •. ., i <br /> P / <br /> Date Issue ' r " <br /> -------------------------------------------------------- ---- ---- <br /> --------------------------- --- This Permit Expire <br /> s 1 Year From Date issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfiall the work herein <br /> described. This application is .made in compliance with ounty Ordinance No. 549 and existing Rules and R iigulations: <br /> -----'--CENSUS TRACT --- <br /> JOB ADDRESS/LOC N -- <br /> _�- Z'------ - -- ----- � ` # <br /> Phone - - i� <br />""�"""'Ow>1er's'Name'___ ` <br /> City __ 1�7F �---- = / <br /> Address ------------------------------ ------------------------------ ��� Y�1- _._ <br /> Contractor's Name ---------------- /'#l'VISA LZ �_ y-C - License # -14045-11------ Phone <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial NT <br /> Court l❑ <br /> Motel ❑Other -------------------------------------------- I <br /> rJ ---------- <br /> Number of living units_____________ Number of bedrooms _____-�__-_Garbage Grinder __..-______ Lot Size _ <br /> -- --------------------------•-- -------------------------------- <br /> Private ❑ <br /> Water Supply: Public System and name ------- - i <br /> Character of soil to a depth of 3-feet:w­Sand, _.Silt❑_,clay-.p_ Peat❑ Sandy Loam [] Clay LOOM '10 <br /> lY e ---- -------- <br /> Hardpan ❑ <br /> Adobe Fill Material if es,type <br /> 7' '";' " `� f buildings, etc. must be placed on !!reverse side.) <br /> +11 <br /> (Plot plan, showing size of lot, location of system m relation to wells, <br /> NEW INSTALLATION:` (No sept0fank or seepage pit permitted if public sewer is available within 200 feet,)�I <br /> w ; Size---------- -------- ----------------------- Liquid Depth - ------------- ---------- W <br /> SEPTIC TANKl <br /> PACKAGE TREATMENT f ] [ ; <br /> Capacity --- --- ---- Type -------------------- Material--------------- ------ No. Compartments ----------- <br /> Distance ito.nearest., <br /> ---------•Distance.,`to,nearest: Well ------------------- - -----------Foundation ---------------------- Prop. Line ---------------.---•-- <br /> . .,_ �. - ; <br /> ---- Total Length ---- ------•--------------•- <br /> LEACHING LINE [ ) No. of Lines ------------------------ Length of each line..____.------------- 9 <br /> t d Depth-Filter Material ---•----1i--- ------------------ <br /> i 'D'�Box ---------.Type Filter-Material ------------- ; � � t a r- <br /> ' ♦ . 4• Pro a line <br /> Distance to nearest: We - ----- Foundation ----------- P rtY <br /> ! Depth f Diameter ------ k------ Number ---------------------------- Rock Filled Yes [] No <br /> SEEPAGE PIT [ l p - ------ - ` <br /> Water Table Depth .. �.-------Rock Size -------------- <br /> �4' <br /> I ` x t _: - Pra, "Line ---------------------- <br /> Distance to nearest. Well ______ ___________ ________ <br /> Foundation p• <br /> lP-T ,�, �,��. ------:---- Date ----------------------------------) <br /> RIEPAIR/ADDITION(Prev. Sanitation Permit# ----------------- -- <br /> • ! ------------ -� r <br /> - -- - <br /> Septic Tank {Specify Requirements} ________________lf.----------- --�-- � i <br /> 4 q� -- - ----------- ----- <br /> Disposal Fie (Specify RequJ encs) �_O_-_=c_C _--• - ---- -- "' 7 �_... � <br /> ------ ------------ <br /> e <br /> + -------- --- <br /> -1y <br /> _ _ ___ ____________ _______________________________s_y_ _____.__--_______---_________-_ __4_T _ <br /> w i. <br /> ------ ------ _ <br /> I (Draw existing and required addition on reverse side) 4 <br /> I hereby certify that ) have prepared this application and t4at the work will be done in accordance wi4h San Joaquin' <br /> County Ordinances, State Laws,}and Rules-and Regulations of the.San Joaquin Local Health District. Homellawner or liven sed agents sign ature;certifies the'following: +, <br /> "1 certify that i the perfor me of the work for which this permit is issued, 1 shall not employ any personi�in such mariner <br /> as to become s jectite W man's mpensation laws of California." <br /> =; Owner <br /> G ' Title <br /> Signe ------- - --- - --s- ------- - � - --------- -------- ------- - <br /> -- ------------------ -I <br /> By (If other than ow ! <br /> ner) <br /> ' FOR DEPARTMENT USE ONLY <br /> n— <br /> "-----)DATE - ----- <br /> ` -------- -------•- <br /> APPLICATION ACCEPTED BY ---------------------------------------------------------------------------------------------- DATE ----------------' <br /> BUILDING PERMIT ISSUED ------------------ ------ - <br /> --- -------------- <br /> ADDITIONALCOMMENTS --------`---------------------------------------------------------- ----- <br /> --------------------------- <br /> __ ---- ---- -- <br /> - ------ - - <br /> -------- --------- ------ - -------- -,Date --------- ---."--- -------- ---•--- <br /> ---------------------------------------------------------------- <br /> Final Inspection by <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT j <br /> E. H. 9 1-'68 Rey. 5M <br />