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FOR OFFICE USE: , <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------ --------------------- r , <br /> F `\ (Complete in TriplicateY ' Permit-No_6!-__=� <br /> _ .f:/ <br /> ------------------------ <br /> ------------- --------- t-----._____-_____-_-____ This Permit Expires 1 Year From /bate Issued ' Dente Issued :�?Ca <br /> Application is' <br /> 'hereby made to the San Joaquin Lacal Health District for a I'lpermit to construct and install the work hlerein <br /> described. This:application is made in compliance with County Ordinance 11No. X549 and existingi Rules and Regulations: > <br /> JOB ADDRESS/LOCATIONS ! - T7p--vre3_ --- -------------------CENSUS#T <br /> � ACT ------ -----``-f----------- <br /> e R <br /> Owner's Name :------A4-& --- ----L aR E'` y• 1 <br /> j oqD Phone: = <br /> N <br /> Address l-�i�,�w _ j_�9_ '-/4 r G�' C'v O!] - t <br /> f <br /> Contractor' '! f f l , a,— n��s l <br /> Ph <br /> --- <br /> r - ------- Ci-----.License # -sY_ y3 Phone6 `__ �a <br /> 11 _ �- <br /> r. i [ <br /> Installation will.,serve; Residence ❑Apaftmrit House❑ Commercial: <br /> EjTrai6rCourt ;D;(oq�PZ, -ip�„� i <br /> Motel ❑Other � <br /> Number <br /> of 9j' <br /> r of bedrooms-n Garbage Grin-der -.-----fl <br /> _-�-- Lot Size -----i-------------------------------------- <br /> Water <br /> I <br /> -----------------•--- <br /> ----_----- <br /> WateSupply: PublecSystem'-and WaneReivR - ------- ------ --- ---- --------------------------- ------Private 0 <br /> Character of soil to'a depth of 3 feet: Sand 12' Sift❑ Gay E] Peat❑ Sandy Loam Clay Loam ;❑ ; <br /> Hardpan Adobe []- ' --�--- �- <br /> t p El Adobe '❑ Fil!"Material _ If yes, type --------- --------- - <br /> ! --------- # <br /> (Plot plan, showing sire of1.lot;_loc�rtiora ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic}tank ors page pit permitted if public sewer is available within 200 feet) {€ <br /> PACKAGE TREATMENT' , SEPTIC TANK'[i] I ------- :__-- - -_ <br /> Capacity(; 040 6lj*'D,Type ---------------- --- Material-- __-- N_ -------------- <br /> ------------ <br /> 7- No. Compartments <br /> ;Distance to nearest: Well --------------------------r. -------FoundationVf - - * <br /> I _ n t- -i } �• i = --Prop Line . <br /> 1; I:� i} 9 �I i 9 <br /> [ ] No, of Lines - -- Length of,each line----------------'- _- Total Len th�_____-------------:_--- _-- <br /> LEACHING LINE� i D Box ����`�' j .� . �� r l ^' t{�i• I Wit• <br /> r <br /> yr Ypetlter Material --.___- - -- - Deptl filter Material :_ ._..- ----------- - •___-- <br /> VDistance to n rarest: Wel'I --- -------------------- <br /> --- ------ ---Foundation --------------- <br /> ---------- Property Line --- E --•--e----•--• <br /> SEEPAGE PIT <br /> Depth ---��`�' Diameter J�L 6�� _ Number ------------ --------- t <br /> + p -- ---;- Rock Filled _Yes ( No I❑ <br /> Water Table Depth ! 45-6 t- <br /> i - tom �• -=- --------------------------------------Rock Aize ------ / -------------- <br /> e -. <br /> tl k ��5"Q- L---•----.-Foundation ----A)0 L �Lr= f <br /> I l j, --------------- - Prop. Line ----------- -------- <br /> Distance to nearest: ell <br /> REPAIR/ADDITION'!(Prev. Sanitation Permit#'_________ _________ <br /> Septic Tank (Specify Requirements) -. ____.____-- <br /> � ----------------------------- <br /> Ili <br /> Disposal Field Specify Requirements) - -------------------------------------------------- _ <br /> ` ff ------------ <br /> F --------------- , <br /> - ------ ----------------- ---- ------------ <br /> ---_ ____________________ _ ____________ i <br /> ' (Draw existing and required additi6n-on--,e <br /> verse side) 3- - ,:, . -ic _ �. -;: <br /> I hereby certify, that 1 have prepared this; application and that the work III 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 ilicen- <br /> sed agents signature certifies the followi g: f <br /> "! certify that'-in the performance of they ork f `which this permit is issued, i shall not employ any person in such m niter <br /> as.to'b-ecomersubject to Workman's Compensation laws of California." <br /> e V i � <br /> ` - <br /> Signed ` ; "z Owner ,i <br /> By --- ------------------- ----------- -------------------- ----------------------- Title ------- <br /> --------' - <br /> il '� - f- --- ------------ ---'----- <br /> (Ifj ther than owner) � � ! � ---f ' <br /> i <br /> FOR DEPAitTMENT USE ONLY <br /> APPLICATIONt-A'6 EPTED BY -- -- -- ----- -- ----- -- z ' t <br /> - ------------------------------------------- f -------. DATE - J I <br /> BUILDING PERMIT TISSUED ------------- ) -i-A----------DATE ------------- € <br /> N L <br /> -------- CO;MME°NTS <br /> ----------------- ------------- <br /> ---------- ------------------------------------ ' t1---------- <br /> - -----------------k-------------- - --- --------- ----------------------------------- -' <br /> - _ ---- -F'F <br /> #' <br /> -------------------------- s' - --------- --------------------------------------- '--j - <br /> Final Inspection'by: _ ¢' <br /> ---------------------(---t-- --------Date _: � �_ ---- <br /> x SAN JOAQUIN LOCAL HEALTH blSTRl T> ' <br /> r <br /> E. H. 9 1-'66 Rev. 5M \� \l \� .0 <br />