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-FOR OFFICE USE: - IT <br /> APPLICATION FOR SANITATION PERMIT <br /> ....................... Permit No. <br /> (Complete in Triplicate) <br />..:........................4 .............:....... This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to consfruct and install the work herein <br /> described. This application is made in compliance with County Ordinance No". 549 and existing Rules and Regulations. <br /> I ,j 0SS'v�J, EL ECJ �v1 .ST D.] 2 J <br /> JOB ADDRESS/LOCATIO .............. .:......... -z . .. ....... ..........CENSUS TRACT ...................._.. <br /> Owner's Name /.�d1I :;Jb 1 l.�ll-�-:. T on ..... S <br /> e —� <br /> �}- . :-- ...... ..Cit �n ........................................ <br /> Address .......... ....Q...46Q74.... . .. 7.. .:.._.. <br /> Y <br /> Contractor's Name�f_i. j--- <br /> Installation <br /> 10.52,57-1-1..:_ Phone �t�� .Cr . <br /> Installation will serve: Residence 0 Apartment House f] Commercial [3Trailer Court- 0 <br /> Motel Other . _ <br /> Number of living units:,._- ", .Number of bedrooms -.Garbage Grinder ...�.,-__.Lot Size ...................................: <br /> Water Supply:.Public System and name ---- ��.` � . ..........................:.............:..Private ❑ <br /> .S- <br /> Character of soil to a depth.of 3 feet: Sand E] Silt C] Cloy ❑ Peat❑ Sandy Loam 0 Clay Loam <br /> F , <br /> Hardpan l a <br /> Fill b <br /> Adoe FiMteria .. If yes, pe.... .... .... , ..-___. - <br /> , type : T O <br /> (Plot plan;- showing size of lot, .location,ofsystem .in relation to wells; buildings, etc. .,'must be'. placed :on reverse side.j � <br /> NEW INSTALLATION: (No septic tank;or seepage 'pit permitted if public sewer is available within 200 feet,) ? , <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ] Size. .............:...... .....:...... ------ Liquid Depth .. �� <br /> . _ <br /> Capacity ...... Type' Material.._.,................... No. ' Compartments . <br /> Distance to nearest.- Well ....... ......... <br /> ounda#i n . . Prop. Line, <br /> LEACHING LINE [ ] No, of Lines ................. ....... Length', of each line.-- .------ --._ TotalLength ...•--..................... <br /> y <br /> 'D' Box T e Filter Material ::....:::.Depth FilterlNotericrl <br /> Distance to,nearest, Well -- ------------- Foundation ...-_.-•--.a: ._.,._....°Property Line --+ <br /> SEEPAGE PIT [ ] Depth ................... Diameter ............. Number ..:....:................... Rock Filled 'Yes ❑ , No C <br />{ Water Table Depth Rock Size --- ................ <br /> .. <br /> Distance to neare'st• a Foundation' ..___. Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit. ....................................... <br /> r <br /> Date .........:..:................} <br /> fSeptic Tank (Specify Requirements) ---- ---- -- f ... <br /> Disposal Field (Specify Requirements[ ...:.... . ......J �.. .'.. -�� _�r it[1. .......................... <br /> (Draw existin and requir <br /> •----••---------- ----------•----------------------=-------- -------...._ -............ <br /> .-•-=--•----•......•----:---- ....._.............-=----._...._....._.:::....... <br /> Ir g ed 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. Joaquim <br /> k County Ordinances, State Laws, and Rules and Regulations of'the San Joaquin'Wheal Health District. Home owner er licen-z I <br /> sed agents signature certifies.the following:. . . . <br /> "I certify that in the perforrnra a of the work For which this permit Is issued,:l shall not employ any person in!such mdnnera <br /> t as to become s , t to�Work an's Corripe tion laws of California:” <br /> Signed ......... _0........:.... ... . ...:' ... ...::r... Owner . i <br /> i ...._.. <br /> BY .... .:............... ..... .... -- -- isle Y i <br /> t (I at r t an owner[ i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ... ........... <br /> . . .......................................... ............... ...... DATE.. ..fO,..- -:.'7 ..... .... ; <br /> = ---- <br /> BUILDING PERMIT ISSUED . --------------------•------- ----------_- ;........ ....---'--..... :.. .... <br /> ADDITIONAL COMMENTS ........... ........:............ .....:......: -----......................................................' .. ---- <br /> .. , . .. .. . .DATE ... .. . . . . . <br /> ..................... .................. _ .. _. ... . . s <br /> .. . .. ... •-- <br /> Final Inspection ---•-••---- -...........-_Date ............ <br /> SAN JOAQUIN :LOCAL HEALTH DISTRICT <br />? ,. <br /> 11 94 , 7177 1.M <br />