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=FFICE USE: APPLICATION OR SANITATION PERMIT <br /> Permit No. _--�e c�_.._.___ -- {Complete in Triplicate) Date Issued-- -------------- --- r✓ TYiis Permit Expires 1 Year From Date Issue <br /> Ordinance No. 549 and existing Rules and Regulations: <br /> I ere-- made to thle San Joaquin Local Health District for a permit to construct and install the work herein <br /> Application ;s hereby <br /> l described. This application is made ;n compliance with _CENSUS TRACT - <br /> i 1 phone`�r' a ._ <br /> l _ / /� <br /> JOB ADDRESS/LOCATION ._ <br /> `- =------------- <br /> I. Owners Name ----- - ---- ---- ------------- <br /> / <br /> -- ---- ---- ---- <br /> r - <br /> .e <•- <br /> ,! City '' l <br /> 1 Address ....... � 1. �y ;$•.� Phone _f..�L/ -- ---Q----- <br /> _, i!4 License # 17 J e. <br /> s Contractor's Name - � k,. Trailer Court .Q <br /> A artm-ent House,[] Commercial <br /> Installation will serve: Residence [71P <br /> Motel ❑ <br /> Other ---------------------------- ---- --- --- <br /> Lot Size ---- <br /> • �_ Number of bedroom ­4&7-t Garbage Grander _----------- �---- ---- <br /> -------Private <br /> Number of 1yv`Publ c15 stem and name --------------- ------------- <br /> g - <br /> Water Supply: Y me --------------------- - Clay Loam ❑ <br /> Silt:[] ;1�13yPeat Sandy Loam ❑ Y <br /> i <br /> Character of soil to a depth of 3 feet: Sand❑ 1f yes,type .---------- <br /> Hardpan ❑ Adobe <br /> aterial{ YP <br /> y etc. must be placed on reverse side.) 1 <br /> F {Plot plan, showing size of lot, jocat,onYof system in relation�to wells, buildings, I <br /> #.�"' <br /> I NEW INSTALLATION: (No septic flank or seepage pit permitted'if Public sewer.is available within 20 feet,) <br /> Liquid Depth =k - <br /> I � Sizes'----------------- <br /> SEPTIC q _•��a <br /> PACKAGE TREATMENT [ ] TANK'[ } ��T No. Compartments <br /> ICa acit Type ------ -------- <br /> -- <br /> Foundation -- ---- ----------- Prop. ane - <br /> Distance to nearest: Well _- Total Length --------- -------------•---- <br /> i No. of Lines -----.- Length f each line---- <br /> .LEACHING LINE [ } Depth Filter Material -------------------- ----------------------- <br /> 1 - erial ------------------- <br /> D' Box _- --- ---- Type Filter Ma� _ ��� -- -..:',-- Property ILine ------------------------ <br /> 1[ <br /> ------------- -•-••--•- <br /> i to nearest Well ------- <br /> Distancer FoundtTtioh ------- <br /> Depth Diameter ----- <br /> Number Rock Filled Yes ❑ No 0 <br /> SEEPAGE PIT [ 1 P _ <br /> 1, �------------•------•----- <br /> ------Rock Size ---- -------�----------------- <br /> Water <br /> - -------- -----+ . <br /> Water Table Depth -----------------� <br /> I ------------------ <br /> --- ----------•---Founda#ion �----- --�------- -. Prop. Line ----------------••--.. <br /> Distance to nearest: Well _----------- t <br /> t --- ----Date ------------- <br /> ---------- <br /> ----- <br /> - ---- ----- ------- -----------) <br /> t <br /> Tank (Specify Re u nation Permit# -------- <br /> ( p Y q X11 <br /> REPAIR/ADD17lON(Prev. Sanitation <br /> ___ _- --- - � ------------------------------- <br /> Septic ._. <br /> tk � r __.---- --- :----------- <br /> Disposal Field (Specify Requirements) --- ! ! I t ---------------------- <br /> ------------------------- ---------f---------._ I <br /> 1 -------- - - --------------------- i--------- ----------------------------------- <br /> ------------ --------------------P ------------- <br /> { <br /> I ---------------------- e 4 <br /> )Draw existing and regui.r_ed:add.;tion_on.reverse side} I <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 Regulcitians of the San Joaquin Local Health District. Home owner or licen- <br /> f s the following: j1 y <br /> sscertify that in the performance of the work for which this permit is issued, 1 shall not employ any p <br /> ed agents signature certifieerson in such manner <br /> as to become s ject to orkman's Compensation laws of California." <br /> Owner <br /> ---- <br /> Signed --- r�"� ----- ------- ------- ------ ---- --- <br /> --------------- <br /> BY <br /> Title i <br /> ! (if other tha owner} F. <br /> FOR .DEPARTMENT USE ONLY <br /> ------------------ <br /> JDATE - `ST'C2_ -------- <br /> C =r :. r�: <br /> tt APPLICATION ACCEPTED ;13Y .__` - -DATE ------------------- ~ <br /> - --BUILDING 'PERMIT`ISSUED`------ ------------------------------------ --------------- <br /> ADDITIONAL COMMENTS ------•----------------------------------------------------I ------ <br /> I. <br /> ----------- <br /> --------------------------------------------i-------------------- - --------A------Y - ----- ----- ---- --------- --- ------ ----- ---- <br /> 6 <br /> c'----- <br /> ----- ----------- ae . - - - � -- <br /> ------------- <br /> �1 /f <br /> Final Inspection by: ---. = �I. SAN JOAQUIN—LOCAL •-HEALTH DISTRICT <br /> F <br /> E. H. 9 1-'68 Rev. 5M <br />