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_�.=�•e - .� ..,:J, ,ter <br /> -FaR OFFICE USE: <br /> - ---------------------------•----- --- <br /> APPLICATION FOR SANITATION PERMIT 7� rQ7l <br /> - Permit No. '-- ----------------- <br /> (Complete in Triplicate) <br /> -------------------------------------- This Permit Expires 1 Year From bate Issued <br /> Date Issued <br /> Application is hereby made to the San" Joaquin Local Health District for ap ermit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> PP � <br /> JOB ADDRESS/LOCATIOfN -- - c�-7 ._.-- r--IL �?19 ----------------------------CENSUS TRACT ---------------,.----•---- <br /> I Owner's Name <br /> f--Q------- 4 �' 11�------ ------------------------------„------=-----------------..-_Phone --(-�- ----- <br /> Address ---- Sc2 / r - = city � j -------------------------­--- <br /> Contractor's <br /> -F-------------•--------------- Y --•-------- '--- ---`--- - <br /> Contractor's Name .-- - - AI "v -c_ ------------------.License <br /> #�M�U� Phone7 _ <br /> Installation will serve: Residence [Apartment House-E] Commercial ❑Trailer Court ;❑ <br /> I <br /> Motel F1 Other -------------------------------------------- <br /> Number <br /> - - -------------------------------Number of living units:.---1___-. Number of bedrooms• -_----Garbage._Grinder --— Lot Size ------ <br /> Water Supply: Public System and'name ---;------------------------------•--------------------------------------------- ----`---------------------------Private J1 <br /> 10, <br /> Character of soil to a depth of 3 feet: Sand:E] Silt fl � Clay Peat❑ Sandy Loam •❑ Clay Loam 1* <br /> Hardpan ❑^*WAdobe'❑ FilllMaterial -- =--TIf-YeS;tYPe - == <br /> t 1 + I ! ----- <br /> (PI'ot plan, showing size of lot, `location of system in relationFto�wells, buildings, etc. must be placed; on reverse side.) y <br /> J; - f, .r __ _ <br /> NEW INSTALLATION: (No'septictorM-or seepagd -pit permitted if public sewer is available within 200 feet] +l <br /> PACKAGE TREATMENT ( ] SEPTIC TANK'[ ,'r Size_- _ _-_ - ,X--� -__-Liquid_Depth - --------------- V+ <br /> Cap °J yp MaterialiQd6CX4� No. Compartments <br /> p accty� Q� - T e ' <br /> ;' + i o <br /> Distance to nearest: iWell -��_-______________________Foundation -��_ _--_______ Prop. Lime _�4�..-._..._._ <br /> LEACHING LINE [� No.•of Lines -- ---------- Length'Length' of each line__ _�-------- ------ Total Length, __1740--l_----___ <br /> V, Box ----S_- Type.Filter.Mater,ial.I � .....Depth Filter Material _ ��-------------------------------- <br /> a 10, <br /> £Distance to nearest: Well,-- p:_.--.--_.__ Foundation 0--_ - --- Property Line <br /> \.� j ll 1 + t!\ v-. N- — ” — �- <br /> SEEPAGE PIT [ 1 Depth ___+____----_-_-i Diameter --- ------------ Number -- <br /> ------------ Rock Filled Yes 0 No 0 <br /> Water Table Deptfi '- <br /> ---------------- -'---------------------Rock Size -------------------------------- <br /> Distance <br /> ------------------------------- <br /> 4 nearest! ti f <br /> REPAIR ADbITION Prev Dianitation PermitWell-------------------- <br /> ___---- �---� ---------------------Foundation -------------------- Prop. line --------..______._..__ <br /> { I f I [ 1 <br /> T rf <br /> - ---------------------- Date ------------------••-•---•- ------ <br /> I <br /> SepticTank (Specify Reui�emerits) ------------#--------------------------------------------------------------------------------------------------- --------------------------- <br /> 'I I + , i ,i <br /> f Disposal Field (SpecifyRequirements) -------;--- -••------------------------------------------------------------------------------------------------------ <br /> _--_-------------------`--------------.-----" ------ - . <br /> - I <br /> ---- -------------------------------------- ------- ---------------------------------• ------------------------------------------------------------------------------------- ------------- <br /> ", �(DPciw existing and required addition on–reverse'sicle)�-= <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 District. Home owner or licen- <br /> sed agents signature certifie's'�the fallowing: zi 9 <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 1Norlcmap's Compensation laws of California." ; <br /> Signed ---. Owner <br /> ------ --- --------------------------------- - -- -- <br /> By ------ --- `?Y� t ------------------------- Title QC' .ElfJl ) <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY I <br /> APPLICATION ACCEPTED BY --- -- ------------ --------------------------------------------------------- DATE ------------------------------------•-•---- I <br /> BUILDINGPERMIT ISSUED .----------=I------------ --------------------------------------------------- --------- --------- -----DATE ------------------•---------- ------------- <br /> ADDITIONAL COMMENTS --------------1 - + <br /> + t <br /> ----------------------------------------- -•-•-------------- ---------------------------------------------- ---------------- <br /> --------------------------------------•------ --------------------------------------- ----------------------------- <br /> Final Inspection by-- --------------------- --- ---------------------------------------------------•------- --- - ------- Date -- --- -------------------- --- ---------------------- <br /> SAN JOAQUIN LOCAL HEAL . DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />