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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ................•--•-------....---.._....-•-------•-- .� <br /> (Complete In Triplicate) ' Permit No. .X- `�'� <br /> d ...................-------------------------------------- This PerniitExpires ] 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/LOC�TION .._.�lp�.� ...........................................CENSUS TRACT ................. <br /> Owner's Nome A.1Z_/Z.-� �...�...�. �.��2..:............... ...................................Phone91--- <br /> Address ._.1(0� <br /> v_. <br /> -. ._...... � ................-- ---•. ............ city ..".1 <br /> Contractor's Name . _ ._ L.C�.../_.,r111J G.IZ, ..•---------.License # -,34,Y7 1.... Phone .. .4'�.�:--3p� <br /> Installation will serve: Residence 930'A'partment House Commercial []Troller Court <br /> ,I Motel ❑Other ......... ........................f <br /> Number of living units:------------->Number of bedrooms ... Grinder .._.. ...... Lot Size _2 _r.pn....................... <br /> Water Supply: Public System and name .----"--......................................................................................................Private <br /> Character of soil to a depth of 3, feet:_-Sand o Silt Q Clay ❑ Peat❑ Sandy Loam Clay Loam n <br /> t Hardpan I] Adobe [] Fill Materlol ............ If yes,type ............... ............ <br /> (Plot plan, showing-size-of lot, location of system In relation- to wells, buildings, etc. must be placed on reverse side.) <br /> k NEW INSTALLATION: (No septic tank q.seepage pit perinitted if public sewer is available within 200 feet',) <br /> v <br /> PACKAGE TREATMENT f ] SEPTIC TANK t ] Size................................................ Liquid Depth ..........................� <br /> % <br /> Capacity . No. Com artments r <br /> •-•-•...............�.TYPe -••--....---•-------_Material..................._. . .... . <br /> Distance.tb• nearest: Well ' ...:_.Foundation .......... Prop. Line <br /> _....... <br /> LEACHING LINE [ ] No. of Lines :.................... . Length.of each life----------..—.__........:_ Total Length ._.._-•----.......... ...... <br /> 'D# Box ------- Type Filter'Materidl .............---.:-_.Depth .Filter Materlal ............................................ <br /> Distance to nearest: Well ........................ Foundation Property Line <br /> SEEPAGE PIT '[-]-----Depth - ---------- ------- Diameter _.._.._.._.._ Number ---------------------------- Rock Filled Yes [J No (3 <br /> NAN <br /> Water Table Depth ------------ ------------A---------------- <br /> _ .'�_ .._._.:...._......-. ::..Rock Size ..... <br /> Distance to nearest: Well ------------------- ------------•--..Foundation -----_--------_-__-. Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _-- ..----------•.................. Date .................................. <br /> } <br /> 1 Septic Tank (Specify Requirements) ------- ................. ------------------------ <br /> ....••• . -- •- --..._._.....---....._...... <br /> p.-..........._... .. .......... <br /> Disposal Field (Specify Requirements) ._..___....IJ• ---_--.... QQ �!_ 1.-U <br /> - .r .e .�? ..._.(� ---------------- <br /> E -------V4 ..._ .., .....4- .2.' ------ ..... <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:I <br /> "I certify .that in the performance of the work for which thisperm t is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's.Compensation laws'of California.',' <br /> # Signed ----- -- ------------- >- s------- J Owner <br /> S -----------------------•- <br /> $Y o -----._....- - - Title AWX4C.._. <br /> a {If other than.,owner) _ _,:, ,,,,,;' � • <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYC ------ --------------- -------------- ... DATE ..SS.Z-�--�- <br /> BUILDING PERMIT ISSUED ---- -------------. --_----------------- = - DATE .........._................................ <br /> ADDITIONALCOMMENTS -------------------------- -----•- --':..' ----------------------------------------------------- ........................... <br /> ----------- -------•- - ---------------•--------------- -------------------------•-------•.-4----------•-•---'" <br /> ...- <br /> ........................... ----------------------- -------... --------------------------------------- <br /> r <br /> ---------------------------------- <br /> Final Inspection by: =-U_7--.. T " Date �. J.:...._.L... <br /> ............. ----------- ._..._.._...... .�r�. <br /> EH 13 2h 1-68 Fay. 5m SAN JOAQUIN LOCAL HEALTHr DISTRICT:; 8/7lt 3M <br /> f • �1 <br />