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FOR OFFICE-USE:" APPLICATION FOR SANITATION PERMIT ` <br /> Permit No: <br /> ----- ----------------------------- (Complete in Triplicate) <br /> -------------------- - Q <br /> --------------------- <br /> ----------------------------- <br /> Date Issued _._ -(�- � <br /> This Permit Expires 1 Year From Date issue <br /> ------------------------------ <br /> ------------------- t <br /> in <br /> al Health <br /> rict for a <br /> it to construct <br /> l the work <br /> Application is hereby made to the ean complian ecwi h Cou tyt0 d nan a Nom549 d ez st n nRules tand Regulatonsrein <br /> described. This appiica ii `` �, <br /> C ------CENSUS TRACT -------------------------- <br /> ;Z <br /> -•- -- ---�---�--- <br /> JOB ADDRESS/LOCATION __ _ L j <br /> on -------- <br /> -- �.r.�- --- - ----- <br /> `/�• - <br /> Owner's Name _ 0-�--1--/------------ -----------------------•------- ----- - -�-] ..� _ ...� <br /> Address /I ------------------ <br /> Address <br /> �� P <br /> -- .� <br /> �' License # -. �ti ,k one <br /> Contractor's Name -- --z2---�C�1�- -------- ------- - ---�- --- - <br /> lnstallat;on will serve: Residence �artment House❑ Commercial ]Trailer Court i❑ ` <br /> 'Moteli❑Other -------------------------------------------- <br /> 4_. Lot Size 4 -?__,�C `_____________ <br /> Number of living units:.-- ------- Number of bedrooms -----Garbage Grinder <br /> Private <br /> Water <br /> ®_ <br /> Water Supply: Public System and name --------------------------------- ------------------------- <br /> Sand Loam -El Clay Loam [Ik <br /> Character of soil to a depth of 3/feet: Sand'( i1t❑ Clay ❑ Peat❑ y <br /> aterial ------ ---- if Yes, type --------------------- <br /> Hardpan ❑ Adobe❑ Fill M -- <br /> f s stem_.ira relation to wells, buildings, etc. must be placed on reverse side.) \ <br /> {Plot plan, showing size of lot,_location o .y - <br /> NEW INSTALLATION: �JNo septie-tank or seepage pit permitted if,public sewer is J`ailable within 200 feet,? V\ <br /> r .....�- _ L; Depth --------•------- <br /> PACKAGE TREATMENT- [ SEPTIC TANK fk-, -X- ` quid De p — <br /> f __ Materlal�� ' No. ComPartments,9-:---------------- <br /> I Copacity`A,0�---- Type -i -- M : al �t I- f � <br /> Distance to nearest: Well __ - --------- -----=--- --Foundation _/O____---------- rop. Line .- -------------• <br /> t <br /> LEACHING LINE [ ] � No. of Lines ------------- - ------ Length of ach line------------------- -------- Total L gth ---------------•------------ <br /> 'D' Box ------------ Type Filter Materia ----- --------------Deth Filter Material ----- - --•----------•-------- <br /> Distance to nearest: Well ____-_-_-___._------- Foun ation ------ --- <br /> Prope Line <br /> E SEEPAGE PIT [ } 'Depth Diameter -------------- - Number -------- ------- ---- Rock led Yes ❑ No 1❑ <br /> i <br /> --- - _,. ...Rock-Size- J------ --------- <br /> -- <br /> ,Water Table Depth -------------- ' = E <br /> 4 i Foundation op. Line <br /> 4 Distance to nearest: Well ______________________ <br /> ` Date ----------------- <br /> REPAIR/ADDITION = ) <br /> (Prev.LS�anitation Permit# ------------------------------ <br /> Septic Tank (Specify REquirements) r C --1-f__ _�- �� � � l f Y - `----- <br /> v•�l_P__<i- KFi_ i..._ B)lN(>ONE�D------ _Pry- --------------- <br /> t Disposal Field (Specif- Requirements) - - <br /> � oa 614E t �Or11 L= '1? _1 _----` - CQN11� s1 <br /> In�K-s ItV 'Ait� ----- ------- <br /> ` --tE— ---11A_�F----------------- i _ . <br /> (Draw-existing and•-required-add;tion-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 DisFrict. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in he performance of the work for which this permit is issued, 1 shall not em ploy any person in such manner <br /> k as to become subject to Workman's Compensation laws of California." <br /> Signed --- ----- - - <br /> - Owner <br /> 9 f ' � NT;tlew F f <br /> By -- - ' r'�r'f �.i <br /> I <br /> (If other than owner} <br /> �---sY" ---'-FOR7DEPARTMENT`USE-ONLY <br /> _ ---�--------- DATE Z ------ <br /> ----------------------------------------r• ----�- <br /> - <br /> APPLICATION ACCEPTED BY - - ` -.___- `_""`._.' <br /> BUILDING-PERMIT 15SUED ---------------- ----- ------------------_ <br /> i -- --- <br /> = <br /> ate l} <br /> ----= <br /> ADDITIONAL COMMENTS - - ----- -------------- <br /> --------------------------------------- . ----- ------ - ------------------------------------------------------------------------- -------- <br /> ------------ <br /> --- <br /> ---------------------- -- --- ---- - - ----- ---Finallnspec SAN <br /> --- - <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1268 Rev. 5M <br />