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r <br /> �;,F0R OFFICE USE: r <br /> - APPLICATION FOR: SANITATION PERMIT �"���• <br /> ------------- ----------------- .� , - Permit N :� -•- .... <br /> �d <br /> (Cork#e In Triplicate)P ' <br /> " ,�. '.. .!� Date Issued 6?. <br /> r <br /> .............................._-._....__-__.-......_..... This Pe1i4kxplres 1,Year lrotirodtilssued <br /> f Application is hereby made to the San Joaquin Local Health District for a permit to construct tend install the work herein <br /> described. This application is made in compliance with County Ordinance No.-5349,ond existing Rules and Regulations: <br /> JOB ADDRESS/LO TION _- _ ._.. ,...L' I .��" - </•`�-..... .. CENSUS TRACT .....................:.... <br /> 11 <br /> egg 1I2.�¢ ! ..:. <br /> Owner's Name _. _�.... _•--._...... .n ._ 1 ...._..... Phone .......................... <br /> Address �. =......City ��1 .................... ............ ........... <br /> ------ ------ -- .. -------_._ ..... <br /> �,,� Phone <br /> r Contractor's Name - /._ C� .....-•--•----•--._..::.,..."License # .---... <br /> Installation will serve: �4' Residence❑A.partment-House j3-Commercial ElTrailer Court I <br /> f Motel ❑Other ............................................ <br /> Number of-.living units:-.-w__ 'Number of bedrooms ............Garbage Grinder ............. <br /> Lot Size _....z� ................... <br /> 4r I <br /> Water Supply: Public System and name ..............___-----•-.........-------•--••---- .......................................................Privat <br /> Character of it to a depth of 3 feet: Sand o Silt Q Clay o Peat Q Sandy Loam O Clay Loam ❑ <br /> Hardpan Q Adobe 0 Fill Material If yes,type <br /> k (Plot plan,showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) Q <br /> I NEW INSTALLATION: jNo septic tank or seepage pit ,permitted if public sewer 1s available within 200 feet,) ,N <br /> PACKAGE TREATMENT I I SEPTIC TANK[ I Size..., ......................................- Liquid Depth ................... , ... <br /> - i <br /> Capacity ... Type '- ....`,Material...................... No. Compartments ...................... <br /> Distance to nearest: Well ------------------------------------Foundation .................. Prop. Line ...................... <br /> i <br /> LEACHING-UNE No. of Lines ------------_-- Length of each line---------------::...-- Total length <br /> ............................ <br /> I D' Box ----------- Type Filter Material ..Depth Filter Material <br /> Distance to nearest: Well ------------------------ Foundation _-_-.-.................. Property Line ............. ...... 6 <br /> --• Diameter Number ............ ............... Rock Filled Yes No <br /> SEi:PAGE PIT, ( l Depth ... = , a <br /> • <- i � <br /> (31 <br /> _Z; Water Table Depth ------------ .Rock Size 1 <br /> Distance to nearest: Well ...........................Foundation .................... Prop, Line .................. <br /> I REPAIR/ADDITION(Prev. Sanitation Perm...........•-------------- --------------- Date .-_-------- <br /> -----------•-•-) <br /> Septic Tonk (Specify Requirements)._._ /t/.ST.�C. ---•-• -••02-- -----------' s.�C,Z ..... ,;� 0/Z4. <br /> Disposal Field (Specify Requirements) ----- -----...----- - ------------ ......... ............. 11 F .................... <br /> a. <br /> -�--._...._._ZX/ 41 . S.Ttt----------•------------ <br /> .....---•...............I..._ <br /> ----- ----------- --- <br /> L <br /> {Draw existing and required -a`,ddition on reverse side) i <br /> i 1 hereby certify that I have pre Tared this application.,'6 ,that�*s, work will be done In accordance with San Joaquin <br /> f County Ordinances, State Laws 'and mules and 'Regulations of the Sat' Joaquin Local Health.,gistrict. Hoene owner or licen- <br /> sed agents signature certifies the followir+g: <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 /> C as to become subject to Workman's ensation laws of California." <br /> Signed ---------- ---- ---------- --- -•---•--- ---•---- Owner <br /> lBY --Title ------------ --------- -----•••---------------------• ..-------- <br /> (If other tha <br /> FOR DEPART ENT,VSE ONLY <br /> APPLICATION ACCEPTED BY t ' -----=-----•-----• DATE . .1 .7. ._.... <br /> BUILDING PERMIT ISSUED'----'--------=------- :_.. :. DATE _--:--_-_-__-•------- ----- <br /> ADDITIONALCOMMENDS -\_.: ---------------••----- -------•--._...........__._...------------•. -.._....------------.._-..... <br /> .ice i ,4, _� - <br /> �+-. <br /> Final Inspection by: : '----------- _ t, 1---------- -------•------ ------Date �`/. .` ............ <br /> "Fi 13 24 1-68—D <br /> Derr. ]OAQi,fIN LOCAL HEALTH DISTRICT /7 M <br />