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TR OFFICE USE: <br /> APPLICATION FORS SANITATION PERMIT <br /> -------------- /da 7 <br /> )Coplm <br /> ete in Triplicate) Permit No. _7Y T ___---------- <br /> This Permit Expires 1 Year From Date Issued Date Issued <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 ADDRESS/LOCAP4 <br /> ON ._.-.o��D 5 �2----------�l�-AAW-`f, JZ-aR�------------- ---CENSUS TRACT -------------------.....-Owner's Name --------N-------DUl-�----------------------------- ----------- ----.--Phone +`9--------------- ! <br /> Address ----- -------------- ------_N-iJti_lAN---- -=-----R1 pc?rw Cp-----------. City ---------------------------------------------------------------------------- <br /> Contractor's Name --- 14 ►le------------------------------------------------ # Zy. ) g----- Phone _.$.Z 3- G�5------ . <br /> Installation will serve: Residence 9-A-partment House ❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑ Other -------------------------------------------- <br /> r <br /> :Number of living units_____________ Number of bedrooms _____•___Garbage Grinder .-__--__.-__ Lot Size _.IC F 2 'G-� <br /> Water Supply: Public System and name ------------------------------------ - ------------------------------------•-- - -----------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'e Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type _________________________ __ �I <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 /> { ] { ] <br /> PACKAGE TREATMENT SEPTIC TANK' Size______ ____________________ quid Depth ___________...-_-.._._ <br /> Capacit>9 < <br /> -- ----- Type -------------------- Material No. Compartments <br /> Distancrest: II __ ---------- <br /> F ation ______________________ Prop. Line -_.-------.___________ <br /> LEACHING LINE [ ] No. of -------------------- th o�fe ine --------------------------- Total Length _-_-_-...: <br /> b' Sox --------- -- Type Filter Mat _____________Depth Filter Material _____.___.-___- <br /> Distanceest: ------------------------ Foun n ------t,------------- Property Line -------..--._•---..----- <br /> SEEPAGE PIT [ ] Depth _ _-___ Diameter ________________ Number -------- ------- _______- Rock Filled Yes ❑ No,C] & <br /> Water Table Depth ------------------------------------I---•-------Rock Size --------``--�-*--�}------- ---------- <br /> Distance to nearest: Well --- -U__________________________Foundation -_-L-4-- -------- Prop. Line -- 0------------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------..----------------------} ` k <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------------------••- -------------------------------------------- •--•-•---- <br /> - <br /> Disposal Field (Specify Requirements) -----,i a0-------7.1?-------- <br /> --- -------LGA ------ <br /> --- LtArS-- ----- �o....... <br /> "j �'° -(_nok. �'i'� n L ----------Lew ------------ <br /> -------------------------------------------------------------- <br /> ----------------------------------- - <br /> (Draw existing and required 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 Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home 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 becom subject to Wo m'an's Compensation I of California." <br /> Signed ._ -__ __- Owner <br /> ---------- - -----�----y--;------ ----- - ----- ---------------- <br /> C��i c� <br /> By ------- - ----------- ----- ----- I Ti#le <br /> - -- ------------- -------------------------- <br /> If other than owner <br /> OR EP RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- - -- --------------- �Pr,rte--------------------------- ------------------- DATE _ 2Y—------ <br /> BUILDINGPERMIT ISSUED ------------ --------------------------------------------------------------------------- --------------DATE --- --------------------------------------- <br /> ADDITIONAL COMMENTS - <br /> -------------------- =------------------------------- ---- --------------------------------------. <br /> - -- - - --------------------------------------- ----------------------------------------- -- <br /> ----------------- ----------------------- �` <br /> -- - - -------------------------------------------------- <br /> Final Inspection by --------------------------.Date ----------- ---- ------r�---- ------- <br /> -------------------------- <br /> fQ <br /> SAN JOAQUIN LOCAL HEAJTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />