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FOR OFFICE USE! �I APPLICATION FOR SANITATION PERMIT - <br /> Permit No. <br /> .-•...-•--•-•---•-••--•••-- ... ............ . <br /> ._. <br /> Data Issued . �_ .7G <br /> .................... ...................................... This Permit Expires t 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 /> describer!. This application is made in compliance with County Ordinance No. 549 and existing Mules and Regulations: <br /> JOB ADDRESS/LOCATION ...... .�.._,..-- �::C E-�.....1�'�Q:Pr? ..... ....................CENSUS TRACT -- •-----•--•-_----..... I <br /> Owner's Nam ...... r1.L1 _. ....................................................:.....................Phone . . 2....`7.Z..----- � <br /> Address ----9 p 1��J.Y_l t------ a 1/.�.�............................City .6',C,.P.1_.C� -........-•---- •--•• . --------•-- _ <br /> k <br /> Contractor's Name ..................•------License # Phone <br /> Installation will serve: Residence WApartment:House C) Commercial oTraller Court,.0 <br /> Motel ❑Other...........................::.......:........ <br /> t <br /> Number of living units:..../ Number of bedrooms Garbage Grinder I.q.0.. Lot Size `�........... <br /> Water Supply: Public System and name ........................................................_....._.........-.................:_...._...........Private <br /> Character of soil to a depth of S feet: Sand d Silt Q Clay ❑ Peat❑ Sandy Loam 0 Clay Loam 0 <br /> Hardpan❑ Adobe t' Fill Material AVO...If yes,type............... ....I....... <br /> (Plot plan, showing size of lot, location of system in relation to walls, buildings, etc. must be placed on reverse slde <br /> NEW INSTALLATION: (No septic tank or seepage .pit permitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size......,fSf. o...Lj_j.4L.............. Liquid Depth .6.-Ar.............. <br /> / Type '(-CICS=]---- Material.l�.fd �•f Q`�[. No. Compartments <br /> Capacityo.(!g1i 4 sof. 0,.............. <br /> 4 � <br /> T Distance. f nearest: Well .... ..........Foundation ./jO..7F .... Prop. Line R.0 <br /> LEACHING LINE No. of Lines _---_ . Length of each Total Length ....... <br /> D' Box -.._-.. Type Filter Material .� �..A�Depth Filter Material ..9 4.717....................... <br /> Distance to nearest: Well _-f ,S......__-_. Foundation .f.......... Property Line _� .E - -•.•-•. <br /> S IT E ! Depth.&/;" .+:aODtawat+er ................ Number .....j.................... Rock Filled Yes- ' No Q <br /> Water Table Depth Z/0.... -----------....Rock Size I . .. <br /> Distance do nearest: Well --....•.......................Foundation .f__ ....... Prop.time .............,........ <br /> I <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ....................------------------------ Date ...._-_--....--..................... <br /> ] <br /> I <br /> SepticTank (Specify Requirements) ---------------_- .......................-....................=........... ._................-.-.......................--.................. <br /> Disposal Field (Specify Requirements) ----------------- ................................................ ....................................._............... <br /> t -----------------------------•---------••-•--•--------•• --.-...------------. --..-----------------................................... ......................................... <br /> ---------------------------------------- •------ --------- ........................... ....................•......... ..........-•••--.--- <br /> "f !Draw existing and required addition on reverse side] <br /> I hereby certify that 1 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 certifies the fallowing: <br /> "1 certify that in the performance of the work far which this permit is Issued, l shall not employ any person in such manner <br /> as to becomWsu, ct to Work an's Compensation laws of California." <br /> Signed. -_- <br /> ,. .. ............:..................------- Owner <br /> By --------------------------------------------------- title --------------------- ................................. ....------ <br /> (if other than owner) <br /> i FOR'DEP RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ... ,� : --•................•-- :.:.._..._._.:........_.......... DATE,L .7..._...' -------- <br /> BUILDINGPERMIT ISSUED ------------...........................----------------------------------------- -------------------------DATE ---------------------- -- -.....---•----. <br /> ADDITIONALCOMMENTS ------------'--------------.......................................----------------------------------------- ---.---------------........-.....------------ <br /> -------------------- <br /> •---------- --- .. ------------ ............. ...... ...............................................•--....._........-...:.......------•.............---..........._ <br /> ---------------------------------....... - -- - ------ --- - {� <br /> i inol Inspection by: -_.-._... ........................... -----------Dote .� .-f..r.J�. �-------------- <br /> EH 13 2 J`� 1 �• SAN JOAQUIN LOCAs. HEALTH DISTRICT 8/74 3M <br /> f <br />