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PPLICATION FOR SANITATION PERMIT <br /> Permit No: <br /> (Complete in Triplicate) <br /> --------------------------------------- <br /> Date Issued ::_-_ <br /> --------------------------------------------------------- <br /> This Permit Expires 1 Year From Date Issued ; <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> i i <br /> JOB ADDRESS/LOCATION s___IgT7 T------E-------I/W ----1�2-©---------------Elk!------CENSUS TRACT __-_S"�7��x-_--- <br /> Owner's Name --------------R----------F ----------------------------------- -------Phone -------------------------------..... <br /> Address ---- - - IEVE!n -----D}------------------------------- City __ 'lQp STM----------------------------------------------- <br /> Contractor's Name --lVa-D_--_C_O_ + �' ''' <br /> .r1LIV���-------- -----;-------------- Phone ------ - -----�.-------- �: <br /> - --------------------------------------License# ---- $'2Z <br /> 1525 MfFP+- ��p M4b T� . <br /> Installation will serve: Residence Apartment House Commercial Trailer Court <br /> Motel ❑Other ....`"`-------------------------------------- i <br /> Number of living units:------ ___- Number of bedrooms ------Garbage Grinder --------- Lot Size _ h'h14 �--------------- <br /> Water Supply: Public'System and name ------------ -------------------- ------------------------------------ -----------------Private <br /> Character of soil to a'depth of 3 feet: Sand"(] Silt❑ Clay ❑ Peat❑ Sandy Loam {] Clay Loam ❑ <br /> Hardpan ❑ Adobe.E .Fill Material NO--- If.yes,type ---------------------- <br /> (Plot <br /> --------------- ----(Piot plan, showing size of lot, location of system in relation,t well's, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic 11 to k or seepage pit permitted if public sewer is available within 200 feet,] Ni <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [-J' °' Size-_- X�;� X _. __ ___ Liquid Depth <br /> { <br /> Capacity J _ ___,:_-kType�Ovl r^ _�Materfal AFS} _ TF-- fo. Compartments �"" <br /> - <br /> Distance to nearest: Well,-I- �__' -x-__________-.Foundations/Qi+-"f`.---._- Prop. Line ------ <br /> LEACHING <br /> --_-LEACHING LINEn <br /> No. of Lies __ _________ ___}'_ __ <br /> [6]� -I ___ <br /> ��-_ Length of each line:--�--: ___�Q_ Total Length .---- <br /> _ '.��� <br /> D' Box �i�s_�;Type Fil#er,MateridT ©� -_-__Depth Filter Material ______ ___l_ ___________________________ <br /> �... <br /> Distance to nearest: Well ---�Ot--------------------- Foundation ___ + _____________ Property Line ----�--t----------- <br /> SEEPAGE PIT [ ] Depth --.-.--.-.-;n- ;-- Diameter ---------------- Number ---------------------------- Rock Filled Yes 0 No <br /> Water-Tabie- Depth ------------=------------------- ----- --------Rock Size -------------------------------- <br /> Distance <br /> ------------------------ -----Distance to nearest: Well ----------------------------------------Foundation ---------------.---- Prop. Line ...................... <br /> REPAIR/ADDITION(Pr6v. Sanitation`Permit# -------------------------------------------- Date ----------------------------------11 <br /> Septic Tank (Specify Requirements) ___c ________-------------- - 4 <br /> Disposal Field (Speclfyr Requirements) ---------------------------•--------------------------------------------------------------= <br /> ----------------------------------------- <br /> -------------------------------- j - ---------------------------------------------------- ------------------------------------------ ------------ ----------- ------------ <br /> V� <br /> �X.} - (Draw existing and required addition on reverse side) • ' <br /> ,,,I, hereby „cern . ,that ),have- re aredTthis a li�tien Anel that rhe wo"k 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:- <br /> "I <br /> ollowings"I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to sub, t'to Jbrkman's Compensation laws of California:" <br /> Signed --- ------- e ------- -------- <br /> - ---------'L --------------------------------------- Owner <br /> By ------------------------------- -------------------------------------------------------------------- <br /> --- Title ---------------------------------------- --------------------------- E <br /> (If other than awner] *� r <br /> FOR DEPARTMENT USE FONLY <br /> APPLICATION ACCEPTED BYgip.-C' --------------------------------------- ------------------------� DATE <br /> BUILDING `PERMIT- ISSUED-----—4- = LL.---� --. -- - �----�--- .. ._- ----=`__--DATE—. _-= „" <br /> ----------------------------------------------------------- <br /> ADDITIONAL COMMENTS C � CQAfCR� HA_ a 'f_C'S'Q1w`C'fi-) x --- -------------- <br /> --- <br /> -- <br /> -------- -------- = -------------------------------------------------------------- ----------- <br /> --------------- <br /> - - -- -- -- -- - - ---- - <br /> -- - ------------ ----- -------------- -------- ---- - --------------�� z: <br /> Final ion b --- D � <br /> L - - <br /> ------- -- . ate -- -------------- -------- <br /> ------------------ <br /> --------------------------------- <br /> - ---�+ <br /> j SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M I <br />