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FOR OFFICE USE:. <br /> APPLICATION FOR-SANITATION-PERAl M <br /> "" Permit No. R <br /> 1Complete In Trlpllcatel <br />..........I-••••._.-- •-•-•.........:. ....... -t <br /> Data 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 werlc h®rein ; <br /> described. This application is madein compliance with Cou`­nty7 Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LO TION .. �i .1. -- _t. r � .: :..... -- - ....... .............. ...........CENSUS TRACT ........... <br /> Owner's Name- ' -... ++�.. one ._._.. .... <br /> 'Y'I :............ ........Ph �� �.��------- <br /> Address - -f "rG h City ----•••• '. ` ..............a ......... <br /> •-_. ... <br /> �_ _ <br /> License# �� .... Phone <br /> pc� <br /> Contractor's Name ...... = =---........_........ • �R. ................ <br /> Installation will serve: Residence Apartment House0 Commercial Trailer Court Q <br /> i.Gtt ss-r�l <br /> Motel ❑C+ther6... .. -- -- •- - - ,�,,..�,:::,.-.... ! <br /> Number of living units_____________ Number of bedrooms ------------Garbage Grinder ............ Lot Size ....... ................. I <br /> Water Supply: Public System and name •..•----•----- ............................ ........._-................ ................................ - <br /> Private � <br /> Character of soil to a depth of 3 feet. Sand Q Silt Q Clay [:], Peat Q Sandy Loam Q - Clay Loam <br /> .- Hardpan p - Adobe-Q Fill Mpterial ............If yes,type............................ <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 seepage pit permitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT [ ] SEPTIC TANK it ] Size--•............................................. Liquid Depth .................... S' <br /> Capacity - Type Material-------------- No. Compartments <br /> Distance to nearest: Well _-----=---k:. - -______-.......Foundation _...__.•......... .... Prop. Line ....................... <br /> LEACHING LINT: [ ] No. of Lines ------------------------ Length of,each.line....---..................... Total Length ....._..___._ .............. <br /> D' Box Type..Filter Material .................. .� " a _ Depth Filter Material <br /> Distance to nearest: Well ............ Foundation ........................ Property Line ....... <br /> - .__�_ --• =-�'" Rock Filled Yes 13 'No <br /> SEEPAGE..PIT--�[-] '""A'•Dep#h �": 'Diameter -----------------Number......- __..... � <br /> E <br /> Water Tale Depth .............Rock Size i ` F <br /> 1. : ti <br /> . <br /> Distance tonearest. Well .Foundation _ Pro <br /> Prop. Line ~' <br /> REPAIR/ADDITION(Prey. Sanitation Permit 4 ..•- --------....•;-•••--------- ---'Date ............................... 1, <br /> + <br /> Septic Tank (Specify Requirements] <br /> Disposal Field (Specify -R <br /> } .....................; <br /> . equirements} _/ .r- ........ h _ ..........-•_•.............................. ............. ........ <br /> I: <br /> --------------------------------------------------------'--------- ----•-----•- ----------- ---------- --............----•--------------------........._...........................- _...........-. <br /> �\ <br /> k J(Drow existing <br /> and required addition on reverse side) <br /> 1 hereby certify-thaaJ have-prepa rid.-this.,application-antt_th at the.work will. be.done-in accordanee with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations o(-the :San Joagvin„ii.o�al Health;Distdct. Home owner or licen- <br /> sed agents signature.certifies the following:l �-'� .s° - r a--.�-W�. °�•~' -- -- - �^ ;, <br /> "I certify that in the performance Of the work for-which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed --------- --------------- -- -------- +_------- -••--• Owner r <br /> BY ---------•--....._ Title ------------------ <br /> (I oth t n owner) <br /> FOR DEPA OW <br /> APPLICATION ACCEPTED BY -- -- --------------------- --------- <br /> -----• •• `............ DATE ".�'.,.b.-2�_....--------_-"__---- <br /> BUILDING PERMIT ISSUED ------------------------------------._.. --•-- DATE ".. - <br /> ADDITIONALCOMMENTS ----------------•..-........----•.................._........................ ............ -----------------•-- ------------ <br /> f Final Ins ection b ---•-------------•---"_------•----- ----- .. . C,� ... Date - �.?. .".. <br /> EH 13 24 1-68 Rev. 5 SAN JOAQUIN LOCAs. HEAL DlSTRiCT 8/7h 3M <br /> `-6 <br />