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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> �o...............I._........__ <br /> (Complete1in Triplicate) Permit No. .-76. � <br /> ''"""" •••. ..• This Permit Expires 1 Year from Date Issued Date Issued ..&.. 73 <br /> Application is hereby made to the San Joaquin Local Health District for a <br /> described. This application Is made in compliance with County Ordinance No; 549rmitoand existing Rulesconstruct andtalndt Re work egulationsrein <br /> JOB ADDRESS/LOCATION ...... <br /> _ NsuS TRACE <br /> Owner's Name _y..�lL .� S,�I._ ..S�d.7�e F� _ _ �. ._M ,_ . .................... <br /> H� _ <br /> F ......_._..-•--•••.. <br /> Address c� �+I)`�v �' ...._ one .................................... <br /> ............................ .........•....... Cit �3' c %�Te� <br /> Contractor's Name ._.._,,1.�.c.�i..� .. -.-.License # � --------..........•-••--._......__•.......,.. <br /> ------..._ •--•-•--•--- ._ Phone f'r�r�l.. <br /> Installation will serve: Residence {Apartment House[] Commercial oTraller Court 0 <br /> Motel j]Other ............: <br /> Number of living units /..• Number of bedrooms _&;......Garbage Grinder :............Lot Size .__-_____...._ <br /> Water Suppfy._I?vbfic_System and name ....._••-......••-•""-.. " v <br /> -......_....•,. T........ ---------------------- Private <br /> Character of soil to a depth of 3 #ee- Sand �] `Silt 0 Clay �] Peau[} Sandy Loam [] Clay Loam L] <br /> Hardpan [] Adobe'[] FiflMateria -.W. __.If yes,type --- --•- " <br /> i <br /> (Plot plan-, showing size of lot, location of system in relation to wells, buildldmgs, etc must be placed on reverse side.j <br /> NEW INSTALLATION: t � <br /> _ {No septic yank or seepage pit permitted if public sewer is available within 200 feet,) �e 6 <br /> PACKAGE TREATMENT <br /> ( ] SEPTIC TANK t ] t <br /> Size._ ............. ��_ .,,. � vi ; <br />' � - -.... Liquid Depth <br /> Capacity A. ,�e ...... Type i��'�t!Y��_ Material.._._._ <br /> ............... .No. Compartments ....... r <br /> ....- <br /> Distance to nearest: Well .._..�l�_-.rf............... � � � <br /> k .-•----...Foundati� ../..0.............• Prop. Line • �-•••...__ <br /> LEACHING LINE [ ] No. of Lines > <br /> -- _:------ Length of each line--1•f✓--�!... ............. `, <br /> " " Total Len�,yyth <br /> ./ . Type Filter Material j <br /> 'D' Box � ' <br /> i `� Depth Filter Material .. _1�.. <br /> Distance to.nearest.. Well _ f•-/__ -_._ •__ <br /> i ------•-. Foundation ..tp-•�---•-}•------ Property ..�. <br /> �..—_.. s p rtY Line ...�:................ y <br /> SEEPAGE PIT ;[ ] Depth .........__ Diameter j -.i Rock Filled Yes ®t No [j e <br /> ------- - Number .. - <br /> F . Water Table DepthRock Size , X11 1 <br /> ........... <br /> REPAIR/ADDITION }` <br /> Distance to nearest: Well Foundation = <br /> I .� --• Prop. Line ..._ . <br /> -� ON(Frau. Sanitation Permit#--•--- ............................... Dote ........•--- � --- <br /> Septic Tdnk (Specify Requirements) J <br /> i. <br /> Dis osal •Field (Specify Requirements) . ...... ..........---........ <br /> ••------------------------------ --- <br /> +�-� <br /> ...___•.......... ..................... ._.-...__- <br /> 1 -, -•-----i.. ............ ........I..........---- ._.._.. <br /> {Draw exisfing and required addition on reverse side) • . ...-------- <br /> 1hereby certify that I have prepared this.application and that the work will be done in ate rdance with San Joaquin <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District:Homeowner or Iicet,- <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 betaine subjec to Workman'I Compensation laws of California." # I <br /> Signed ...._... �• - - - .... r <br /> �.... Owner �-- - <br /> By .. F ... at er than•- -. .. owner).............. <br /> (If . .......................................... y..^3'itle �_y.. __.......... i. <br /> _...._"...._....._.............. .......... <br /> { <br /> I FOR DEPARTMENT USE ONLY <br /> APPLICATION 5ACCEPTED-�BY—­ - <br /> _ z_aDATE ..�-�- <br /> BUILDING PERMIT ISSUED •-------• <br /> ........................ .................................................DATE <br /> ADDITIONAL COMMENTSC, <br /> ...... <br /> .................................................... <br /> - _ _ -- -- <br /> •_..•--...---•-•................. ..- •. <br /> Final Inspection by ................--•..................................Date .._ _ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 241-'68 Rev. 5M <br />