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, FOR OFFICE USE- APPLICATION FOR 'SANITATION <br /> .a T {Complete in TriPermit No: <br /> plicate) <br /> ti <br /> - Date Issued J--,�lJ--7U <br /> From Date Issued <br /> --------- <br /> This Permit Expires Year <br /> Application is hereby made i�b=fhe San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> y ' 1 c S -------------CENSUS TRACT --------------•-------- <br /> JOB ADDRESS/LOCATION ----1.1--5--- --R--1- — -- <br /> " one <br /> n ( _ 7 <br /> Owner's Name ---- �.. !l l� k ------ <br /> ------------------------------------ <br /> ----------- <br /> � y <br /> Address 1`�fry5.� AltY _ <br /> 1 -- - <br /> ------------------- - <br /> License # '� Phone --_- --- <br /> Contractor's Name ------ �••--= -- �-�- ---------- -------------------------------- ; R <br /> Installation will serve: Residence ❑Apartment House-F1Commercial❑Trailer Court ❑ <br /> t Motel F-1 Other -_! � t <br /> 1 - -- _- --------- r E <br /> Number of living units:j_____ _.-: Number of bedrooms _. -----Garb❑ a Grinder _1jlQ'--- Lot Size � <br /> L <br /> Water Supply: Public System and,,home -------- ------------------------------------------------- '-------------------------- ---------------------PnvateX <br /> V 3 <br /> Character",of soil to a depth of 3 feet: Sand'❑ Silt.[-] Clay F] Peat ElSandy Loam ❑ Clay Loam E]` <br /> 'A Hardpan ❑ Adobe' Fill Material -----I------ 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 septic tank or seepage pit permitted if public sewer is available within 200 feet,) / <br /> PACKAGE TREATMENT { ] SEPTIC TANK j S' - 3`- ----- ------- --------- Liquid :Depth __� '-- ----------- <br /> Compartments <br /> ----------- <br /> �'V <br /> e Na. Com artments <br /> --- <br /> YP _64214 - �+ p = <br /> Capacity �_� _� --.--- Type --- ��_- ,:l <br /> - �r-------- Pro Line ---�--------------- �s <br /> ------Foundation -----�_-__- P• <br /> Distance to nearest: Well ____� �------------ 1 <br /> LEACHING LINE { ° No. of Lines --------1______________ Length offf each <br /> ch line__---- ----.------ Total Length .__,1 ------------ <br /> 'D' Box __ lI Q-- Type Filter Material 7Z----------- Filter Material _____-4------ -------------- ---•- <br /> Distance to nearest: Well _- — ----- Foundation E___. -- -------- Property Line _- .............. <br /> SEEPAGE PIT { ] Depth . --------- Diameter � i---- Number _---'---- ------?-------- Rock Filled Yes [ No [] <br />' Water Table Depth --------6pp---------------------------------Rock Sizej <br /> �-------- <br /> .-•-Foundi ation <br /> --- p-- ---- Prop- <br /> Line <br /> Distance to nearest: Well ______ f � �- ____ -- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _ ___-____---------.--------------} <br /> Septic Tank (Specify Requirements ____----------------------------------> ------------ ------ <br /> -------------------•---------- <br /> Disposal. Field (Specify 'Requirements) ------------- <br /> --------------------- - <br /> t <br /> s ---------------------------------------------------- <br /> -------------------------- <br /> i - <br /> ._.___._._Y__-_.___._ _ _ _ _ <br /> {Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work Willi 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 sign1.ature 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 become subject to Workman's Compensation laws of California." <br /> 1 ` P <br /> Signed --- ---- -------------- <br /> Title <br /> -- - Owner <br /> �_ --- Title <br /> B ' ------ ► t <br /> riy%-- (If)A�rthan owner) ~i <br /> i ,• FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ ------------------ -----------------. DATE _ r Q <br /> - <br /> E�UILDING PERMIT ISSUED' ----------- -- ---------------------------------------------------DATE - ----------- ----------- -------------- <br /> ,,DDITIONAL dOMMENTS- -- ----- �J ------------�----•---------------- -------------- ---------------------------------------------------------- <br /> i fig r, ' ------------------------------------- <br /> ----- <br /> - - - ------- -- -------- <br /> -- ____ ________ _____ <br /> - Date - d <br /> - -- ------------------ <br /> Final Inspection b r <br /> ° S N JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. �, W <br />