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r F <br /> FOR OFFICE USE: ,scs7 APPLICATION FOR SANITATION PERMIT <br /> Triplicate) <br /> r Permit No. JL S- ------ <br /> (Complete ini <br /> P , <br /> --------- ------------------------------------ Date Issued <br /> --------- ------------------------------------------ <br /> This Permit Expires l Year From Date issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made inZmI'ance with unty OrdinStq e Noexisting Rules and Regulations. f <br /> JOB ADDR SS/LOCATION __1 __ -- - -- � ------ <br /> CENSUS TRACT -- S_ 7__..-------- <br /> kOwner's Name --- -------A__0-10_P'x Phone ----------------------------------- <br /> City -- �to01_ -------------------------------------------- <br /> Address - '155 Ile- ' --�r o d�-__Z <br /> - --c ----- <br /> Contractor's Name _ � -- -4 � '4' �i G j"_K------------ # - -I r _ Phone --- -------- <br /> Installation will serve: Residence %Apartment House-[] Commercial ❑Trailer Court Cl <br /> l Motel ❑ Other -------------------------------------------- - "+r <br /> g ��---- Lot Size ----��_7r-� f�e'�`s---------- <br /> Number <br /> "- ---•--- <br /> Number of living units:_._-" Number of bedrooms _�----_Garba e Grinder <br /> Peat Sandy - -------- --------------Private l <br /> Water Supply: Public System and name ------------------------------------.------- <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ ❑ ❑ Clay Loom <br /> Hardpan Adobe F-1 Fill Material ------------ If yes, type __--____--__-__.__--______ <br /> I (Plot plan, showing size of lot, location <br /> cation of system in relation to wells, buildingsr etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r`11 <br /> i :/ ' �' Liquid Depth ----A/ -------------- <br /> PACKAGE <br /> ----- --- - <br /> PACKAGE TREATMENT [ I SEPTIC TANK Size_______ - ---- --- --- q P <br /> pz qLT e- ' -- -------- Material v�� �.- No. Compartments ---1----------=---- <br /> � � Capacity�-/�-------�'- YP -�-�- - � <br /> i <br /> Foundafiion '-- Q"---------: Prop. Line __�,✓..----`----- <br /> Distance to nearest: Well _____-r _ =----- --- - ` <br /> __-- Length of each ------------ Total Length ------- '©�----- <br /> L ch line------ <br /> ==-- <br /> LEACHING LINE, , K No. of Lines _ - -- ---- g �� <br /> 'D' Box 1-,/--=--- Type Filter Material --- ............ Filter Material _______ -""-"------------• <br /> F _ Foundation _ ---J-------- . --- ---/-----._..._ <br /> Distance to nearest: Well ---Z�------------ Property Line - <br /> SEEPAGE PIT ['. Depth _. _` ------- Diameter __� �-- Number _.__--.. -------------- Rock Filled Yes No ❑ <br /> Water Table Depth -----------$?-----------------------------Rock Size ------ ------------------------ <br /> or i /Q4 ....... Prop. Line ----------- <br /> Distance to nearest: Well __ _--------------"-----Foundafiion <br /> 1 Date ---------------•--- - ----------) <br /> REPAIR/ADDITION[Prev. Sanitation Permit# ----------------- ------ <br /> Septic Tank (Specify Requirements) - --- ----- ---------- --- <br /> Disposal Field. (Specify Requirements) _______________________________ _ _________ <br /> ------------------ <br /> (Draw- - - -----------and----------------------------------= <br /> -------- ---- - <br /> ----------------------------- ----------------------------- <br /> -------------------------------------------------- <br /> - <br /> existing required addition on reverse s+cle <br /> I hereby certify that I 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. Hoene owner or licen- <br /> sed agents signature certifies the following: <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 /> as to becomes lett to Workma 's Comnsa ' laws of California." <br /> Signed --------------------------- Owner <br /> - '-------------------- <br /> Title ------..:7 - . •+�----------- ---------------------------- <br /> By ------------- <br /> (If other than owner) <br /> I FOR DEPARTMENT USE ONLY <br /> ' ----------------- DATE -er`�•II-�--?�- ----------- ----- <br /> APPLICATION ACCEPTED BY .. - ---- - -- - ------------------------------- ------------- <br /> - ------ ---- <br /> BUlLDING PERMIT ISSUED ------"-`---------------------------------------------------------- <br /> -------------------------DAT ------------------------------------------- <br /> ADDITIONAL COMMENTS ---------'--------------------------- ---------- ------ -- - <br /> •-------------------------------------------------------------------- <br /> ------------- ---------------------- <br /> ------------------------------ ------------- ----------- <br /> ----------------- ---------- ---------------------- --------------------------- <br /> -- <br /> --------------------- --------------------------- <br /> = ------------------------------------------------------------------------- .� <br /> ---------- =---------------- - ------ <br /> Final Inspection by:`" <br /> ---- ---- - - -- --------------Date - <br /> ` SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />