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r FOR OFFICE ?1SE: �, <br /> APPLICATION FOR SANITATION PER,Mii. <br /> ' ---------------------V---------------------------- - Permit.No: -'_ <br /> (Complete in Triplicate} <br /> /'_aA .-.--.- This Permit Expires 1 Year From Date Issued Date Issued -.- --------- <br /> Application <br /> pplication 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 Regulations: <br /> JOB ADDRESS/LOCATION .- �`Z.Q----�-- ��i!_- CENSl1S TRACT � --- <br /> {:. V. ------------���-�-►-�� - ����,' ------------------------- <br /> Owner's Name - --------------- --- --Phone ------------------------------------ <br /> Address <br /> --- ---- ------------•---•----- <br /> Address -----------Pt-&­-Box--------- City 6 J <br /> Contractor's Name --------OWN-E�-----------------------'' `: = =. i----License # ---------:- ------ Phone --------------- -----•-- <br /> Installationwill-serve:---•- ------'Residence-❑Apartment-HouseQCor�rnercial-BTrailer ii F.-; <br /> i ? R���T. •� �, F w` <br /> Motel-E]Other --------------t G ba a Grinder :�•�_ Lot Siz <br /> t' <br /> Number of living units: - --.-- Number of bedrooms g e g <br /> € J1 <br /> Water Supply: Public System and name _______________ - ` --- ---- --------------------------------------------------------------Private. <br /> Character of soif to a depth of 3 feet: Sand' Silt, Gay ❑ Peat[] Sandy Loam ❑ Clay LoaMx ❑ <br /> dobe ,,�F,ill Materi. Iti -_-_-_,If yes, type - ----------------------- <br /> we <br /> __ _` <br /> Hardpan ❑ ❑. a _ -:,._�- -. <br /> _ =...f_ <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 seep pit permitted if public sewer is,avoilable within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ Sizer X_1- __xLiquid Qepth _ +------------- <br /> Capacity <br /> - _•-----_ <br /> t <br /> r C sptance �"ZO�nearest. Wepe �-�MaterialFp�`��o Y�Ja,�Compartments <br /> r U - Prop. Line 4 <br /> LEACHING LINE No. of Lines --.-----------------i__- Length-of each- line-__=_- --- <br /> g i :- Total Length _ ------------ <br /> 'D' <br /> �� <br /> iD_ Box c �-�_ Type Filter Material R-pct_---DepthFilter h aterialj -----�._ ..........-_--.i--'•------------ <br /> Distance to nearest: Well #-_,ark. =-_I Foundation _-1 _"t----- Pro er Line -- -:-_:____ <br /> j P tY <br /> SEEPAGE PIT [ ] Depth, --- Diameter Diam'eter -------------- - Number = -------------------- Rock Filled Yes '© r No 0 <br /> I ! Water Table Depth ----------�----------------------------- --------Rock Size ---------------------------- i. <br /> jDistance to nearest: Well -'--------------------------------------Foundation -------------------- Prop. 'Line --------............. <br /> I - <br />• <br /> REPAIR/ADDITION(Prev-Sanitation-Permit-#,)---------------------------------------- —Date-- � <br /> Septic Tank (Specify Requirements) ------------------------------------------------------------------------------------------ - ---------..--t,.-' <br /> I --------- <br /> a 1 , <br /> Disposal Field {Specify Requirements) ----- - - 1 <br /> - <br /> s --- -------=."` th-;--.1_6' i.1,1L------ ------1- <br /> jj _ (Draw existing and required addition on reverse side) ' <br /> 1 hereby. certify that I'hav� prepared this application and that the work will be done in itordance./with San !Joaquin <br /> Coun'ty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health bistri'tt. Home owner for licen- <br /> sed agents nature certifies t e following: i I <br /> 4 <br /> "I certify in th erforman f the work for which this permit is issued, I shall not employ any person in such manner \\`; <br /> as Lo be a subi tb-Work s Compensation?laws of CaliforAin." <br /> Signe. - - � _ !Owner a <br /> BY ----------- ------- ----- -------- -------------- -------------- -- - Title - ] <br /> j (If other than owner) j I <br /> f <br /> FOR DEPARTMENT USE ONLY r I <br /> APPLICATION ACCEPTED_ BY --------ITt------'0r-� - <br /> - DATE --� = I ' <br /> PERMIT ISSUED - -_-_,--:--�_ �_-- - _ k-:---- _.--- .- i-.=- _ _ _ <br /> DATE --- <br /> BUILDING <br /> art_ , ; 1`tl- - fl � C3' - '-- �JTtE � <br /> ADDITIONAL sMMENTS +� F' �1ni, 5, 4��- - ------- <br /> �?15�. D. 0 N / ------------------------------------------ �. <br /> ------------- <br /> Final Inspection by: --- E------- - -- ----- <br /> ------------ <br /> ---------------- <br /> --------- <br /> Date Q" <br /> QsZ <br /> SAN J AQ LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. SM . <br />