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FOR OFFICE USE: <br /> g �*.,-t APPLICATION FOR SANITATION PERMIT - ---- # <br /> (Complete in Triplicate) <br /> ____- This Permit Expires ] Year From Date Issued Date Issued <br /> Application is hereby-made.to the.San Joaquin,Local-Health-District_for- a­permit=to-constructpand-•install the work herein j <br /> described. This application is made` in compliance with County Ordinance No. 549 and existing Rule's and Regulations: <br /> JOEL ADDRESS/LOCATION._.. -L_U/ _f __:_"'W- 1-(�Y_ _!- --- �/� - � _�----CENSUS TRACT ------- ----------- ------r �1� <br /> Owner's Name ___ _ .__ _4 <br /> Address ----------------------- ••----- r <br /> �^ ��___ <br /> Contractor's Name --- �..?_�;--M- ------------------------------------------•--- - - <br /> __.License #9!0.3 Phone4fMP��--- <br /> Installation will serve: Residence ❑Apartment House❑ Commercial wraileir Court ❑ SAL43 7W A I L � } <br /> Motel ❑Other ------------------------------ ------------- ; <br /> Number of living units------------- Number of bedrooms ------------Garbage, Grinder ------------ Lot Size ----------------------------------- .; <br /> Water Supply: Public System and name ------------------------------ -------------------------------------------------------------- ------Private <br /> MI <br /> Character of soil to a depth of 3 feet: Sand' Silt. ClayPeat Sand Loma#m Gl Loam.❑ _ 4 <br /> Hardpan ❑ Adobe _ Fill Material ___ __ If yes,type _Sl____ ___ ________ _y ! <br /> (Plot plan, showing size of lot, location of systernr n,relation to wells, buildings, etc. must be placed on reverse side.j__� <br /> NEW INSTALLATION: (No septic tank or seepage pit:rpermitted if public sewer is available within 200 feet,) CI <br /> PACKAGE TREATMENT [ j SEPTIC TANK.� Size______' _ .`� q p '+' "V ' <br /> Capacity _ Qtarest. <br /> Ty'efj j _I�Z4f—_ Material____��1.�.acde7-No. Compartments 6-')-------Distance ton Well ------------------------------------Foundation ---------------------- Prop. Line ---------- ...... <br /> LEACHING LINE No. of Lines(�_ <br /> _ )_____ ---{------ Length of each line_____ ------Tota] Length -_________________ <br /> D' Box ------------ Type Filter Material �_T��`f `r <br /> �. ---Depth Filter Materia) �-�------------•----------;----------- 1� <br /> _ Property Line ------ <br /> SEE <br /> # <br /> Distance to nearest: Well l�r_!�_____________ Foundation /�______________ p rty ��_____�___._.__., <br /> �-- s► -------------- Rock Filled Yes a No <br /> SEEPAGE PIT [ ] Depth _-_�_�_ _____ Dia eter ��-__�_- Number ____�___,� <br /> Water Table Depth:=`: -----------------------•--= -------stock Size -------------------------------- .. <br /> Distance to nearest: Well"_----------------------------------------Foundation -------------------- Prop. Line ---.---------}____-.__ <br /> t , <br /> REPAfR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date --------------..._...-------------) <br /> SSptic Tank (Specify Requirements) -------------------------------•--------------------------------------------------------------------------------------------------- -------- <br /> Di sposal <br /> - -- <br /> Disposal Field (Specify Requirements) .---- ------ - ------------------------- --- - <br /> -- ------------------------------------------------ ------------ --- - -------- -- <br /> ------- 4---I �---------------------- <br /> A <br /> '- (Draw exis Ingrand required addition on reverse side) <br /> I he)eby certify that I have prepared this application and that the work will be done in accordance with San Joaqu..:_ <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or lice <br /> sed agents signature certifies the followings` . A <br /> "I certify tho!-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 bject toorkmp SC 031n nsation laws of California." <br /> Sign r/VLl -----=------ -- �----�--------- Owner � <br /> BY A--------��-.`'G��-----L'� -`- ---�<`� -------• Title ----- _A"P_ _-------- <br /> If other than owner) ; <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- _ _ <br /> ------------------------- - - ----------------. DATE ----6_0 9'- ._6�----------- ------- <br /> BUILbING=PERMIT--ISSUED ---------------------------------------- -----------------------------------_-------------------------DATE--------------------------------- ------- � <br /> ADDITIONAL COMMENTS ----------------------------------------------------------------- - <br /> ------------------------------------------------------------------------------------------------- ---------- --------------------- -------------------------------------------------------------------- <br /> r ' <br /> -------------------------------------------------- <br /> - ------------------------------------------------ <br /> -- --- -_ - --------------------------------------------------------- - ------- --------------------------- <br /> ----- - <br />,,.•.,._�Final._Ins -------------------- <br /> .-Inspection 6 Date -- 1-�- --�-�-------------------- <br /> p Y' _ __ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />