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;FOR OFFICE USE: AP CATION FOJt SANITATION PERMIT <br /> ..................... ......... ................... <br /> Permit No. <br /> - �._.. . <br /> ...---•--•-•-_.. <br /> (Complete in Triplicate) � 7 <br /> - --- This Permit(Expires 1 Year From Date Issued Date Issued .. ................. <br /> [ Zv <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:dis.ma .e-in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> '7 v�, 4-E .moo �` '' ��!! �o I' iC' L i <br /> JOB ADDRESS/LOCATION :a? 2__ _ l i t--._... �rt� ...AL.. O.-...................... ...............CENSUS TRACT .-_.....--._...._.___-.:.. <br /> Owner's Name ........_.. -- ...........................••------=----•-- • Phone... <br /> Address _-------•--... .................. City ...........................•------------------------••_..... <br /> Contractor's Name ......_/Q.� r_.wULLG.�r.......... ------.License #42 J:5 Phone <br /> Installation will serve: Residence [g Apartment House❑ Commercial []Trailer Court 0 --� <br /> Mote) ❑Other -----__......................... <br /> i " - — N- <br /> Number of living units ..... Number of bedrooms ......_._-Garbage Grinder ._. ........ Lot Size ...! .................................... <br /> I q� <br /> Water Supply: Public System and name -------- ---------------------------------------------------------------...---__--------...__......----•••----•Privote p <br /> Character of soil to a depth of 3 feet: Sand T] Silt E1 Clay ❑ Peat[DSandy Loam 0 Clay loarnE3 r. <br /> Hardpan ❑ `-Adobe.0 Fill Material ............ If yes,type ..................•_-_-_.-_- � <br /> F <br /> (Plot pian, showing site-of_iot,-Iocation_of>,.system-in-relatio.n...to_wells,-build.ings,_etc.�must be placed on reverse side.) �3 <br /> NEW INSTALLATION: ' (No septic tank or seepage pit permitted cif„public,sewer is available within 200 feet,) „! <br /> PACKAGE TREATMENT [ } SEPTIC TANKS ] 1 Siae_:s��XG.Y... .............. Liquidp Depth <br /> .......................... <br /> Capacity ..Mev....-- Type PQ . Material------------------- No. Compartments •-__-. _ .. <br /> e. E Distance. to nearest: Well :..gf;.0 ........:.......... .....Foundatioh,..,/0.............. Prop. Line .-��__ ............ <br /> LEACHING LINT: ( ] No. of Lines}..... . ___.., Length of each Ifne.-_--,,� _'�__..... .___ Total length ........................... <br /> I I ` jV <br /> V. Box .-1..__i-_-- Type Filter Material �'aAA4,.Depth” Filter Material -----A.,............................. <br /> k Distance to nearest: Well '........:.......:...... Foundation Property tine <br /> .-----••------- ---- ....................... <br /> SEEPAGE PIT [ ) I Depth ...._... _:'�:... Dia'm'eter ;_..Z ._...... Number ....._._.•.................. Rock Filled Yes No <br /> r ❑ � <br /> ? Water Table;Depth <br /> ...-----•--.........!.._...-•....................Rock Size _..................•............. <br /> r• tante to nearest,• Well ' ...........:.........Foundation - ._ Prop. Liner <br /> REPAIR/ADDITION(Prey. Sanitation Permit"# <br /> ...y------------ - --------••-•---....._.. Date --------•-••--- ................) � <br /> l Septic Tank (Specifyi Requirements) - •---- ..J............. ....... .........---.....-- ..................... . ........ <br /> ._._... <br /> I <br /> ( Disposal Field (Specify Requirements) ......:• . <br /> ------- ---- <br /> Ij 61 <br /> -------•........................ .........• ..................... -•..............................................._.._..-----••-••.........--•-_..... <br /> (Draw exist ng and requi4&additidn on reverse side) <br /> I hereby certify that I!have prepared this application and that the worVwill b� done in accordance with San Joaquin <br /> County Ordinances, Slate Laws, and-Rules arid'Reguiartions of"tKo San--Joo4'uin Loial Health District. Home owner or [icon- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued; �sha 4ot employ any person in such manner <br /> as to become subject rkma ' ompen:cation-laws.,of-Collifornia." <br /> g / r ned ...... Ll...............••----••-----.....•_-__. Owner-te <br /> Si • z . <br /> BY " --------------------------- ------ - -------- Title .:....................................................................... <br /> (If other#hon owner) ( ? <br /> •�': FOR DEPARTMENT SE ONLY <br /> ,APPLICATION ACCEPTED BY ...............:.............................. !:., DATE __�-..G �`�...---.._._____---- <br /> D <br /> t BUILDING-PERMIT ISSUE -.. .r, _ _ _.W '- --— - - - -- - <br /> ADDITIONAL COMMENTS ..............:-------------------------------- <br /> ...................................--------------------------------------------------------------------- :..... :..VRICT <br /> ------ --------•-- -- ................... <br /> ...........................................-__-----------------------------------------------' ...... <br /> FinalInspection by: .............................................................-...........................__• .....Date . j� �f._.._................. <br /> SAN JOAQUIN LOCAL HEALTH D G�`f <br /> H. <br /> E. H. 13 241-'G8 Rev. 5M 7172 3 --- <br />