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FOR OFFICE 115E: <br /> APPLICATION FOR SANITATION PERMIT <br /> --••- •................................ ��--6� <br /> {Complete in Triplicate) Permit No. . <br /> ..................................... --------•------- <br /> ................ This Permit Expires 1 Year From Date Issued Date Issued .. :; 3�.. <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/LOCATION ........... ............. ....... .... (.t. T.........CENSUS TRACT :.............:..:.:.._... <br /> Owner's Name ............ C ....._1 D.-, r"17 ' .....................................................Phone <br /> Address .._....I .c_.._� C3. ......_ <br /> city �S�a.7�r! .r ........_. = <br /> Contractor's Name ..,.. .., .-L-Gc=. _..._...... -----------------License #4'.� Phone <br /> Installation will serve: Residence {X Apartment House❑ Commercial ❑Trailer Court C) <br /> Motel ❑Other- ...... ........................ <br /> Number of living units,-....1._.... Number of bedrooms-.: ..._-Garbage Grinder„_..�..,_.Lot.Size .. -------- ............:........... <br /> Water Supply: Public System and name .,-------------------------------.--------L..---................--------•----.........• Privateer <br /> Ff <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loa ❑ Clay Loom 0 <br /> Hardpan El ' `Adobe ( Fill Material..._....... If yes, typ �............................ <br /> (Plot plan, showing size of lot, location of system in relation to wells, .buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public=sewer'is avoilable'within 200 feet,) <br /> PACKAGE TREATMENT { SEPTIC TANK { Size...--5 Xv e y-' . ............. Liquid Depth ...- ............ <br /> Capacity ., ------ Type -------------------- Material_........... ......... No' Compartments --•-----.: ........ <br /> Distance to nearest: Well . ...fid......_.___--..-_----�Foundation . P.... .......... Prop. Line ./V ........... <br /> LEACHING LINE [ ] No, of Lines - .�`.. Length of each line.... .��,._.. ...... Total Length G'................ tol <br /> D' Box ---./...... Type lifter Material X9/.-Depth Filter Material ............. . <br /> 6 <br /> Distance toehsorest: Well ........................ Foundation .........3 Property Line ........................ <br /> SEEPAGE PIT Depth �� 7� Diameter ----- _ .......... <br /> Number . .... ........... Rock Filled Yes C No C) <br /> { ] r`>�'..., ....�.._. <br /> Water Table Depth ... ............•---------•-•----......----------Rock Size ........... '..--------.._... <br /> f <br /> Distance to nearest: Well ........................................Foundation ......... -------- Prop. line ........_.:----------- <br /> REPAIR/ADDITION IPrev. Sanitation Permit# ------..................................._. Dote ------------.........._ .,_._..-.) �0 <br /> Septic Tank (Specify,Requirements) ---------- . •--------------- .------ i.........---.........•-•-•--•--------•-=--......... <br /> Disposal Field (Specify Requirements) -------------------------•------- ---------------•- ------- .......-..-..... ..... ..... . . ..... ...- <br /> ........... . <br /> ------------------- <br /> ................ ........I...... ............--- --....._.....-----------.....------- -----------------............... . ---- ------.._.. .---- ----------- <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 occordance with San Joaquin <br /> County Ordinances, State Laws, and .Rules'and'Regulations of the San Joaquin Local Health District. Horne owner or licen- <br /> sed agents signature certifies the foil wing: '. <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 subiect to orkm 's. Compensa#can Inw's of California.” <br /> Si9 � <br /> neo <.- �,..------- - -- -'�=- -----------------------------• - Owner � <br /> 'BY _.... .. . ....................r...---•-.......... .................. 1.Jt --�. _....--- Title . ........... ...................... } <br /> cif other than owner) } - <br /> FOR DEPAkiMENT USE ONLY <br /> APPLICATION ACCEPTED BY .�44. /.�E <br /> . :.,.-- ---------------- <br /> .. . DATE ...... ....................... ......... <br /> BUIL-DING-PERMIT ISSUED.::._::.: " r� .. .�.,— .-�, t �> ..._ .:..DATE .`:...._.. w. "`: ";.._�._. <br /> ----- ---• ------------------------------- <br /> ADDITIONAL COMMENTS ................ <br /> ..------•.................... ............ <br /> ...................•.........1...11.1......................... r <br /> .......................... `5J �-------------------------- <br /> ..._.._._1111_. <br /> ._..�...�._.-;__..._..._1111............ ....: .:.. �........._..._._......._.... 1111. ------------------- <br /> ------- <br /> .........._..._... <br /> i� w .. <br /> 111__1................................... _-........ .t......__.--..._..._...--_.....__._......__.........._........_..........._.... - �) <br /> 1111 ..._.. .. <br /> Final Inspection by: 4` - ��---------------------....-•--••-- .-•-------......................Date .._. .. <br /> % ..�Y 1:_:111 <br /> f SAN JOAQUIN LOCAL HEALTH DISTRICT . h <br /> a � <br />\,E. x. 13 24 1.,AA ppw r.et 7 17 91 .4 K � <br />