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0 - - - �'�� w•— <br /> FOR OFFICE USE: <br /> --- ----------------- <br /> APPLICATION FOR SANITATION PERMIT <br /> �I �� (Complete in Triplicate} Permit No. -_7 _�---------- <br /> ----- <br /> �.---, <br /> --- - <br /> I� I �"`Tliis Permit Expires 1 Year From Date Issued Date Issued --/ ---------- <br /> Application <br /> i <br /> is hereby madto the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This applications is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> 7 <br /> JOS" DDRE55/LOCATI N:1--- <br /> : --- ------- ---------6------ ..4IL mm ��h� -y -`-CE SUS 'TR c <br /> - N �7 <br /> T <br /> OR_t---eLL-f},�----------- U q <br /> Owner's Name ------- --`- �' i��N�N •:� - -- --- - ------------�-1-`-�"t <br /> Addrel�s ------------- -=`--- � } -M_fv} City -------------�R' �1 <br /> Contractor's Name EI_jr1//1/ER------------------------------------------------------License # Phone <br /> Installation will serve: Residence ❑Apartment House❑ Commercial:❑Traileti6e; r <br /> Motel ❑Other --------------- F ' <br /> Numb !r of living units:_____ _-- Number,- f bedrooms -�-----Garb❑ e Grinder /} -f�f <br /> .W g Lot Size R -------------- <br /> WaterSupply: Public System and name ---------- <br /> ------------------------------------------------------------------ -------- -----------Private <br /> Character of s:il'to.a depth f 3 feet: Sand' Silt Clay <br /> t, k, ❑r ❑ y ❑ Peat❑ Sandy Loam ❑ ClciLoam <br /> I3�i ✓ Y <br /> Hardpan Adobe Fill Material __;Vb----_____ If yes, type ---_-._____________________ <br /> (Plot plan, showing size of lot, location of s stem in relation 0 1 Y o to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No,septic tank or seeps pit permitted if p blic sewer is available within 200 feet,] <br /> !�1,/a x s- Lc, „ -- <br /> PACKAGE TREATMENT SEPTIC TANK{ Size-.---I ___----- Liquid Depth ---__�,l d_--_____- - )4 1 <br /> Capacity --J Z_C O--- Type P8 A_��Material---GQNRT-7 No. Compartments -_---.--___ <br /> istpnce to rnearest: Well --___A?a______________•-----Foundation -✓a__�" <br /> f --- Prop. Line --------------------- <br /> LEACHING LINE No. of Linen"-{ �__________ Length of each line_--.__P_ -- --____ <br /> ----- Total Length :--- lle�D--------_- <br /> DBox -- Type Filter Material B_dCK_�_Depth Filter Material __----- ` <br /> ------------------- <br /> Dista nce to nearest: Well ___lav i fQ t--1-- <br /> L - Foundation <br /> _GinAr-E uM rr .- ------- - Property Line. -- �--- � <br /> ] Depth _ q ' Diameter 7ii4-x_/,� <br /> Number --_j_7_ --*Rock Fill Yes No ❑ <br /> Water Table Depth --------------- -----------------Rock Size -- --• _ ��_?_I_-�, ` r <br /> r { <br /> Distance to nearest: Wel1r-_�"---f _____-_- /Q --t— --� <br /> �- -------- --Foundatio ----- ----- - ----- Prop. Line,_ <br /> REPAIRjADDITION(Prev. Sanitation Permit' ---------------------------------------- Date -- '} "�' ' ' <br /> 1. Date r - ijjQ <br /> Septic Tank (Specify Requirernents) _______ __________________ ______ i- <br /> ---------------------- `' <br /> 1f IM A J ---------------------------------------------------------- <br /> 0�1 <br /> Disp Field (Specify R Iquirements) z-----------r. ----- <br /> �L <br /> I�_ --------------------------------- <br /> -___--___--------_ ---------------_--__-------- _------_ ---_---_---------_----_----•_-------------_-----_---_--_------- --_------ -_--_-_--_-_-_ <br /> ------------- SIA <br /> r <br /> ---------------- <br /> - --- ----- -- - <br /> I � <br /> ---------=-------------==---------------------------------------------------- - - --- ---- <br /> - - - - ------------------------------ <br /> _ [Draw existing and required addition on reverse side) <br /> I hereby. c6hify 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. Home owner or licen- <br /> sed age4ts signature certifies the following: y' <br /> "1 certifythat in the perf rmance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to becg a sJrMect t ork� an's pensati.on laws of California." <br /> Signed /-=-----`-------- --- ----------------------- Owner <br /> - ------ -- ----- <br /> BY -- I: �� ` � <br /> -------------------------- ----- - ----------- Title <br /> --- - ------------------------------------------------- <br /> (If other than owl ner) <br /> II FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY��'__.-__--' `1 <br /> Q` --- <br /> ------'---------- - ------- DATE ,� -- Z- 7 <br /> ---------------4-- ------------------------.----.- -- <br /> BUILDING PERMIT ISSUED ----II--------------- -- -- -- ----- --------- - - <br /> - ----- <br /> ---------I-----I <br /> ----------I------ <br /> ----';------------------------{---------------- -------------------=-------- DATE <br /> ADDITIONAL GQMMENTS---yla--- _�7:.k_- - <br /> ----------- -" == :a ----------- ----------------------- ------------- -------------------- <br /> -------- <br /> •----- ---------------- <br /> - - <br /> = --------- <br /> - -------- --- <br /> ---------- <br /> -------- - ---- ---------- <br /> - -------- -- - -- <br /> Final Ins-- <br /> -- _ - _= � _--- --- - - ---- ------------------------ <br /> ---- <br /> --------- ------------ <br /> ---- --- Date <br /> — <br /> ?�� <br /> � - --- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRI_ <br /> E. H. 9 1-'68 Rev. 5M <br />