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FOR OFFICE USE: FOR OFFICE USE: a <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------------- <br /> (Complete in Triplicate) Permit No.7.Y_ <br /> ------------------•----------- ---- <br /> ------------------- Date Issued.2_-;L_p'7. <br /> ...................................---------------------- This Permit Expires 1 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 described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION : �../_Y.�� .SS/ .�1. . . ..... ...... ..............:.......CENSUS TRACT.... <br /> Owner's Name_..EGl eSE.CJE_...,G 5,9E.1....... ............... - ........................... <br /> ---••----..Phone... 3 .�3D 83- <br /> -S5 a. . City S rocf�/eo _Zip <br /> 9 <br /> Address. .--- l . ... sso. Sa96/ <br /> 0 17 <br /> Y'343.. Phon . .-..._Contractor's --•--------------- License #_t S --- <br /> � <br /> Installation will serve:. Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel' ❑ Other.' ' ` ` ------•-------------- / <br /> - .�� f <br /> -�. ; <br /> Number of living units:-._._!_:...._.Number of bedeooms._.. _.._.Garbage Grinder .. <br /> = ---_....:Lot•Size___._:I - -..X.f ` --=------ <br /> Water Supply: Public System and name--- ------F--_ <br /> . --............,-.- - ---.------------ ....___Private <br /> ...-----.. <br /> j <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt;[ /Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ ; <br /> Hardpan ❑ Adobet Fill,'Material-- .... ....if yes, type---------------------- <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.5s�pti€'tank or seepage pit permitted if public sewer is available within <br /> /200 feet,) (��\ <br /> PACKAGE TREAT' <br /> [ ] SEPTIC TANKI ) Size-------- - ------ <br /> 5 Liquid Depth.-.: :_. ................ <br /> EX157/X1rj Capacity--- :._. -•Type------ ----- --------Mate�riat----------­-------------No. Compadments....--= -•--- ------------. <br /> �� ��.!Foundation............ .....- Pro Line.------------ -------- <br /> _ �. Dis�ance to nearest: Well................... ............�......` � -.i`. p. ----- <br /> LINE ( ] No.fof Lines ... ••----.Length of each line....•----- Total Length ... .-...... <br /> LEACHING � . � � , <br /> Ex/51/416; 'D'.RBox......._ --T�pe Filter Material__........................Dept.h,Filter Material.-----------....- ----------------- ---------------- <br /> Distance to nearest: Well---------------------- ..Foundation-------------•----. - .- <br /> --------.Property Line -----.. ---.---------- ........... <br /> te <br /> E PIT [. ] Depth.--._._._._.____[diameter.:_-_....:�- ----.Number---------- -------- -------- ± Rock Filled Yes El Na[_1SEEPAG <br /> Water Table De ith ----i` ---- - ft `; ..........Rock Size.-..r'".-......... "------------ ------ <br /> ---- -- �A-_...Foundation •--- �...:',-., ...- Prop. Line........... .... <br /> Distancedo,nearesta, IIIA - t <br /> REPAIR/ADDITION (Pre'v.-Sanitation�P,ermi- #--------/ =3 3 Date--------:-••- ........... - ) <br /> Septic Tank (Specify Re irements)-... - ---------•--------------- ----------- - -- ----- -._....--.. '' -' <br /> .. .v .30.-r . .... --- -----. .. <br /> Disposal Field (Specify Requirements)_ENSTGL.-36__.X-!75.....[�l T__/ _._.�..-----•-- <br /> ••-•--------- -------- - ........................... ----- - ------ <br /> ... -------------------- - <br /> j <br /> r <br /> ri iE'x <br /> (Draw existing and required addition on reverse side) ' <br /> I hereby certify that I have prepared this application and that"the work will be done in accordance with San Joaquin County i <br /> Ordinances, State Laws, and Rules Viand Regulations of the./San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: ) ti <br /> "I cern that in the performance of the work for which this permit ismissued, t shall not employ any person in such manner as <br /> fir p �.,•% <br /> to become subject to Workman's Compensation laws. of California." } <br /> Signed..--- ---------- ------ Owner i <br /> .Title.-------- <br /> By................ ------- - <br /> S7-f, 1/g-Z`� .-------- <br /> (If other than owner) <br /> OR PART ENT ONLY <br /> APPLICATION ACCEPTED BY-.--...._ . /L@--------- _-- <br /> -- - ---- - -- -- ----- --- ------------------- <br /> ---DATE. ----v�- .•�_�_.'�.�......... ......... <br /> DIVISION Of LAND NUMBER. .....--- -DATE.. <br /> I <br /> ....- ------ <br /> ADDITIONAL COMMENTS--------------------1................................... <br /> Final Insp ction by <br /> .. -... -R---------------------------------------- ------------ ----------- ---------- <br /> F&F 21677 RFV, 7/74 3N <br /> Date_ <br /> EH is 2a SAN JOAQUIN LOCAL HEALTH DISTRICT <br />