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APPLICATION FOR SANITATION PERMIT <br /> F6R.(50FICE USE: <br /> Permit No. - e_' <br /> (Complete in Triplicate) <br /> ---------------------------------------------- <br /> ---------------------------------------------------------- This Permit Expires 1 Yea'r' �rom 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 /> 262.3 <br /> JOB ADDRESS/LOCATIONI�--------- ---------- c2r-&-ior'-2r "TRACT -----(5-75--------- <br /> Owner's Name ---- ---------- --------------------------------------------------------j�-----------Phone ------------------------------------ <br /> Address -------T-A-� :5--------C -------�1)----------------------- City ---M-17-CA -------------------------------------------------- <br /> Contractor's Name ------if L7- -n------- ----------------------------z--------License Phone -------- <br /> Installation will serve: Residence [Apartment House,E] Commerciai—E-ITrailer Court io <br /> Motel F-1 Other -------------------------------------------- <br /> Number of living units:---__-__-__ Number of bedrooms --_-_._--Garbage------Garbage Grinder ------------ Lot Size <br /> Water Supply: Public System and name --------------- ----------------------------------------------------- -- _ - ------------Private <br /> Character of soil to a depth of 3 feet: ;S6nd 0 .- Silf 0C lay E] T, Peat[] Sandy Loam -E] Clay Loam E-] <br /> \ <br /> Hardpan E]----A-_dabe:-Fa <br /> Fill Material ---------___ If yes;type --_-_--_-__------::------ - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seep pit permitted if public sewer is available within 200 feet,) <br /> 4V <br /> PACKAGE TREATMENT, J ------------------------ -,F-.On­ ------------- <br /> J_,SFETlC TANK Size,;2�7_0"X 101? ....... Liquid Depth ---- <br /> Capacity _12V00 Type Material_- No. Compartments ----- <br /> --------------- --------- <br /> Distance to nearest: Well ------5V____4--------------Foundation .../ ------------ Prop. Line --------- <br /> LEACHING LINE VI-l"No. of Lines'-7--->------------- Length of each line---- ---------- Total Length ------1 -./------- <br /> V Box/F-_5 Type Filter Material Depth Filter Material- -__---/ . <br /> ------/7-1 _----y------------- <br /> -�-Nistance to nearest. Weil ---5Q___-'{`__ Foundation.: Property Line ------- <br /> 7 * , . ' -­' - .' ' J.- . .. ;%- ­ _._ . - <br /> SEEPAGE PIT -Depth - --- ------- ----- Diameter ---------------- NumVer _­------------------------- Ro'ck Filled Yes No 0 <br /> �._Water Table Depth - - -- - --- -Si - - ----- <br /> Distance to nearest:,W-elI-.-__-___:-�-----------------------k___'-,'Fq,undation -------------------- Prop. Line ------------_-------- <br /> REPAIR�413DIITION(Prev..Sanitatioh­-reiMW1t 9�-------- ----------------------------------- Date --------------------------------- <br /> Septic Tank (Specify Requirements) - e - ------------------------------ <br /> ' -- ---Disposal Field (SpeFifyRequirements) - - ----------- ----- <br /> -11 .- ------------------------------------------�i----------------------------- - ---------- <br /> --------- <br /> ------------------------------------------------------------------------- -- ----- - ---------------- - - <br /> - <br /> ------- ----------------------------------------I--------------------------------- <br /> ' ------------------------ - 7 - <br /> (Draw -kWing-6_d'Tqcired-addition on r.verwsicle). <br /> I hereby certify that I haVe prepared this application and thatjthe work,will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son 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 become subject to-Workman's Compensation" IdWs of California." <br /> Signed --- ----------- <br /> .......... ----------------Title ----- <br /> By -------------------- <br /> Vf other than owner) <br /> '-FOR-DEPARTMENT USE ONLY <br /> J <br /> APPLICATION ACCEPTED BY -------1--j- = ------------ --------------------- ----------------------------------- DATE --- <br /> ------------- <br /> BUILD'ING7'PERMIT-ISSUED'- -------- ----------------------- ------ <br /> ---- <br /> ADDITIONALCOMMENTS --------- 110----------------------------------------------------------------------------- -------------------------------------------------------- <br /> ---------------------------------------- ----- ­/------------- ------------- <br /> 1 -1 --------------------------------------------------------------------------- <br /> ---------------------------------------- ------ - ---------- ------ ---------------- ------------------------------------------------------------------------ <br /> ------------------ --------- - ------ --- ------I-------------- ------------------------------------- --- <br /> ---.Date <br /> Final Inspection -------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />