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rvx OFFICE USE: -____7_ <br /> i <br /> APPLICATION FOR SANITATION PERMIT <br /> ...... ... {Gomplete.in Triplicate) Permit No. ._�.$�•.---•.-__. <br /> ......=............................. ...... This Permit Expires ? Year From Data.Issued <br /> ate 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 CountyPrdinonce No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .p. 'jUJj>1 oar <br /> -... <br /> ................CENSUS TRACT <br /> Owner's Name ......A4.4ll�.'. .� ar-.��_ ........ <br /> ................•-••••_....._.......... <br /> .. <br /> Address ..... ... .. ..... .... _. <br /> .. .. Phone <br /> ..__..Y.__.- .. .. �r <br /> Contractor's Name City /V,� , ....��...... ................ <br /> . .............•-- <br /> --�,_L�-,ice=��� ..._... <br /> .-_--- �? <br /> ••-----•License # ?�-��� Phone <br /> ._.. .a�.��-.--•.--••__-,� <br /> Installation will serve: Residence Apartment House(] Commercial OTrailer Court 0 <br /> Motel <br /> []Other.._._-.-•............................ <br /> �J�C <br /> f <br /> Nuri�ber of living units:_-..>:.__ Number of bedrooms ` <br /> + 1 / 5__--Garbage Grinder ..._._-_..•- Lot Size <br /> Water Su .....Z. :............:. <br /> Supply. Public System and name ___.._._-- <br /> ..............( ..........t[] SLoam � Clay..._....-• ............................................yLoamrivate (� <br /> Character of soil to a depth of 3 feet: Sand�] Silt CIa -. <br /> _Hardpan []_ Adobe 0 Fill Material r'..... ❑ <br /> (Plot plan, showing size of lot, location of system in relation to wells, <br /> buildings, etc. must be placed an reverse side.) I <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted 1f public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK <br /> lSize._ ?� .mol �-_-_-_--- Liquid Depth <br /> Capacity/ -__ TYp�oo, aterial ---- <br /> No. Comportments .. <br /> Distance;.to•nearest• Well <br /> - _..... -•--------•..Foundation -L?..._..... <br /> - ?p. Line; .......... <br /> LINE i <br /> LEACHING [ j No. of Lines � �� <br /> Length of each line-.__ f3 °- <br /> otal Length. <br /> I 'D' Box .: __._._. Type Filter Material 16X.gz-Depth .Filter Material J e .�� - <br /> Distance toI nearest: Well _./.-�--o.!7-•.Foundation _� ._� / <br /> ...-_. Property Line .'rj .._. <br /> SEEPAGE-PIT j <br /> - Depth -------------------- Diameter "."""'��::"'�. Nurriber-_ .......----•- i <br /> Rock Filled Yes C1 No >D <br /> Water Table Depth -`------ Rock ....... <br /> f' l Distance to nearest: Well.- -=---- Foundation I- <br /> .._. Prop: Line ...................... <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ...-"-_. f!- i o <br /> --------- Date-=-------------- } <br /> Septic-Tank (Specify Requirements)p q ._.......... •-.:'-----•-••----- - <br /> ..........................................._. f, <br /> Disposal Field (Specify Requirements) _.-_.____.-__-•• V <br /> # -_ <br /> F <br /> - ..........................................�--�-- <br /> •-•-------_------_......................•} -••---••- <br /> --------6--------•---'----•------ - •... --------------:-------:t. ---------••------I—-------....... �.-•---•.... <br /> (Draw existingand'required addition on reverse side )a IX <br /> Iihereby certify that !,have preparee this application d d,-that,.the work will ba doe in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations 04-tlie San Joaquin Local Haditlr,bistrlct. Horne owner ar:licen- <br /> sed agents signature certifies the following: ._... .r- <br /> "I certify that in the performance of.the work for which-this' e' rm t is Issued 1-shell'°not 6mto any as to becpime sublet r&ma ompensation Taws of Catifarni6."' p= parson in suchmanner <br /> Signed __•C _ .'' •------- ����.._,. ..�_.. <br /> -•------•---------- Owner .. .F <br /> if other th Title <br /> - -------------------------------- <br /> a.._.-.. ,�._�,:...,. an owner!.. _--,�..----- - _ >- I <br /> --------r <br /> OR DEPARTMENT DISE ONLY <br /> APPLICATION ACCEPTED BY _- -- <br /> ---••----- -••---------------------•----•- ---•----,--.DATE._: I_a.-7 <br /> BUILDING PERMIT ISSUED ---• ---• --:..- ,.•.- --- :,, _------._:...: <br /> ADDiTEONAI COMMENTS -------- -------------------- --------------------- - -- ---------DATE ------- <br /> --••----------- ---- ---- ---•._. -• -: --------------- <br /> Finalj <br /> Inspection by: ---- <br /> p y: . -----• .................................._._...---•••----•----------• --- ; <br /> EH 13 2!t 1-6f3 � - ----..-Date -....._.-_ .-"��-�?�..._...__.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT $�7.. s <br /> I� <br /> Ati. � <br />