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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> � � Permit N <br /> (Complete in Triplicate) �..r., �- <br /> _._.... .................... Date Issued ....... /-..Z 2 <br /> ............... .. This PennitExpires ] Year From Date 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 County Ordinance No. 549 and existing Rules and Regulationst <br /> .. ......................CENSUS TRACT ................ . ...... <br /> JOB ADDRESS/LOCATION ....................... <br /> Owner's Name ... +Trr ............................... ................:........_. .....P..one ..... ... .......... <br /> Phone `{ 9�` 7 <br /> Address ... ... -. City ... _._.... <br /> Contractor's Name _.. ..License # . s•`f= -!'3..... Phone ..` . .. .... <br /> l274; .I ►S.h__.. ... M-� <br /> installation will serve: Residence❑Apartment:House fl Commercial oTraller Court <br /> lit ;' > Ma l 0-0tWe--'.......................•---.............. <br /> Number of living units:...._.... Number o€ bedrooms _.::......Garbage Grinder ........:,.. Lot Size . ?f��-.:. ••••� T <br /> Water Supply: Public System and name C-uat.f...... .........___-•• Private ❑ <br /> ............ ................................................ <br /> Character of soil to a depth of 3 feet: Sand b Silt❑ Clays Peat❑ Sandy'L•odni'❑ " 'Cloy loam ❑ <br /> Hardpon-.04. Adobe ❑ Fill 1Npterial -.. '`... 1f yes,.typer:.. R ....... ............ <br /> " f <br /> (Plot plan, showing size of lot, location of system in relation to wells, bvildings,%4tc. must be placed on reverse stile.) <br /> NEW INSTALLATION: (No septic�tonk or seepage pit permitted if public' sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK I ] Size...................... ... :.....:....:...... Liquid Depth .......................... <br /> Capacity _ yP .....�Material---_--... ........ No. Compartments ...................... . <br /> r ` ..... .............. <br /> f Distance.to nearest: Well -------------- :Foundation ........... Prop. Line . <br /> I r - .r <br /> LEACHING LINE ( } No: of Lines . .......... . Length of each line................... ••. Total length <br /> D', Box Type <br /> Filter Depth Material .-- � . -• <br /> . . .............. .. .......... <br /> ..4...__... <br /> Distance to nearest; Well .--.---_.•.............. Foundation ---`......`............ Property Line ;.......i-.� <br /> SEEPAGE PIT ( 3 Depth ---- ............... Diameter ..........:.:.. Number ----.._..__--. ............ Rock Filled Yes ❑ No []� <br /> Water Table Depth -•----•................................... Rock-Size............----.....:......_.. <br /> t I �- <br /> Distance to nearest: Well --------- ---- ••--••--.:..........Foundation .................. Prop. tine ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ................................... -------- Date ...... .................. --•} <br /> 1 Septic Tank (Specify Requirements)..../4e ./� .--R........ v!!.�....�.- j - ..... .. <br /> Disposal Field {Specify Requirements) .do­------­----------------w ------------ ------- .... ....................... ............................_...,._ ...... <br /> s 1 <br /> .__.... ' ------------------ ----- -------- .. ..._..------....----- •--•----•--:. ---._.,......-----........................ <br /> --••-•--------------------- --- .............., .. <br /> ' (Draw existing and required addition on reverse side} <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 Regulations of the San Joaquin Local Health-Disirict. Hans* owner or licen- <br /> sed agents signature certifies the-following:" <br /> I "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 -----------• ------------------------ ------------------- - <br /> litle <br /> BY ------------------------------- ................... <br /> (I# other than owner) <br /> FOR QEPARTMENT i.LISE ON.l -- <br /> APPLICATION ACCEPTED BY r DATE_.:::.:�'"�"��..:.. ::.::..... <br /> BUILDING 'PERMIT ISSUED ------ DATE ............. ............ <br /> ---------------- <br /> ADDITION MMNTS t u �, <br /> g <br /> i ._------- -•---------------------- ------ --------------- ......--•.---. ........_._......---•------------.-_...._ <br /> I <br /> -- <br /> -------------------- ------- - <br /> --------------•-- -...------....._.._-------•._....__. ------------------ <br /> ._...---------- .._..--_----Date ... .._', .. ".._.....--- .......... <br /> Final inspection by--. ..... ... ...� - � - --•------•--•--•----............... <br /> .........................................-- <br /> Eli 13 24 1-68 v• 514 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />