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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ................... Permit No. 7.. - <br /> /.�o (Complete in tripllcatel .............. <br /> _... ............. $ <br /> Doti Issued _ . <br /> This Permit Expires 1 Year From Date Issued <br /> //-/e 7l <br /> Application is hereby made to the 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 /> JOB ADDRI SS/LOCATION 2144 . 9th <br /> __:....................•--•--•--------......---....._..................................CENSUS TRACT ...............-......... <br /> . <br /> Owner's Name ..-. _&obes't C& iby---•-•....................................... .............:....:............... .............. <br /> = ..... .Phone ...................... <br /> Address ---------------------2Z Er._..nth.......................... _:......................... City .................................. ._.- -.................... <br /> Contractor's Name Roto Rooter Sewer Ser. 271539 6 <br /> ---------------- ......._.........License .......... ....... Phone .Zl 5-2616.... <br /> Installation will serve: i Residences Apartment House Commercial❑Troller Court 0 <br /> Motel <br /> 1 ❑Other............................................ <br /> Number of living units:--.......... Number of bedrooms ...3......Garbage Grinder Lot Size ..65x.. ` 0._........... <br /> ' Calif: Water <br /> Water Supply: Public System oM name ............... ...Private ❑ <br /> Character of soil to a depth of 3 feet Sand❑ Silt❑ Clay ❑ Peat.❑ 'Sandy Lociin ❑ Clay Loam ❑ <br /> Hardpan[J . Adobe fl Fill Mgterlakjo...:..:.if yes,type ............... ............ <br /> (Plot plant, showing size,,of 'lot, location of system In relaf(on-to wells, buildings, etc. must'be placed on reverse side.) <br /> NEW INSTALLATION: jNo septic tank or'seepage pit permitted If public sewer 1s available within 200 feet,) <br /> PACKAGE TREATMI=NTC } SEPTIC TANK Size.................................. .... Liquid Depth ................... <br /> Capacity ...... Material...................... No. Compartments <br /> i Distance. to*nearest: Well ....................................Foundation ............... ...... Prop. Line .......................r <br /> LEACHING LINE jk <br /> No. of Lines,......................... Length of each line.......-......................Total Length <br /> u' g 'D' Box ....-------- Type Filter Material ....................Depthe alter Material ........................_._.......... <br /> k; Distance to nearest.• Well ...............•`...,... Foundation ............... Property Line ........................ <br /> SEEPAGE PIT C ) '' Depth .......----------_ Diameter <br /> � •---•-------•--- Number ---------------------------• <br /> • ._ -_< ..�� �• d Yea Na <br /> Rock Filled ❑ i❑ <br /> Water Table Depth .................................................. _. _ . ._.,. <br /> hock Size •---------...................... <br /> Distance to nearest: Well .................. ..................Foundation ................I--- Prop. Line ...................... <br /> REPAIR/ADDITION(Prey. Sanitation Permit ...:................ ....4.._._•-.---_.-_._ Date -------------..................... <br /> ) <br /> F � <br /> ' <br /> ` <br /> ..................................--------••......-•---• ... <br /> ------.._............. <br /> ... <br /> .Septic Tank (Specify Requirements). .........._ <br /> Disposalglcl ftacioequirenents) ......... .add appxLeach end 1-±33" ia.2 existing syste-m- --- bY.......:............ . <br /> ................------.............---..........----------•.-•-•....... <br /> --• . <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this appllcittlon 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-HealtFt.tlistrfct. Ham& owner or Ilcen- <br /> sed agents signature certifies the following: i <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 /> Signed ............ Owner ; <br /> ----- --- - - <br /> Contractor <br /> By - - <br /> ther than owner} -------------------------------- Title ...... --- <br /> FOR DEPARTMENT IJOE ONLY <br /> APPLICATI ACCEPTED BY --------------------- .. DATE ".11/S�_J 5.... <br /> BUILDING PERMIT ISSUED ------"-----------------------•----- --- ------- • ------ ---------- DATE ...._-- <br /> ADDITIONAL COMMENTS.................................. �� /..<.-f-`�". �:...._.... .... <br /> ....................... ..................... ---_-- <br /> .............................................. ._---___-_._7_......_._. _ ,- - <br /> ..___-_».____-- _ - .__- <br /> ------------________________________________________........................................... ..._..._.....__ . <br /> ..... .. _ <br /> Final Inspection by: ..........-------------"-•------------------------•••----<...................... --•--.._. .:... %-�- ..� <br /> • - ---•.Date ......_- ----.�i.._..--�---....---��--" <br /> Fel 13 2h 1-68 Rev. 5i." SAN JOAQUIN LOCAL HEALTH 1tICT 8/7)! 3M <br />