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FOR OFFICE USE: - FOR OFFICE USE: <br /> / F <br /> f V APPLICATION FOR SANITATION PERMIT p� <br /> Permit No. l. <br /> 4 ----- --- <br /> (Complete in Triplicates <br /> -- <br /> - Date <br /> ............................... .. ...... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to-the San Joaquin Local, Health District for a permit to construct and.install the work herein described. <br /> This application is made incompliance with County Ordinance-No. 549 and existing Rules and Regulations: <br /> u ----------------- --- ---- <br /> JOB ADDRESS/LOCATION------3.�..�. ...--- :--- �lwq...J.2�. -------=-------- -- - CENSUS TRACT- <br /> Owner's Name.......... Phone....:r " <br /> cc <br /> Address... - .. y:_%- .. City <br /> ` .............Zip--- <br /> .------. <br /> - .. <br /> Contractor's Name.......... ......... ... e - I.._'Phone, <br /> +'^'�� �S s mj <br /> Installation' <br /> will sere: Residence Apartment Ho`Gs r o mercial ❑ Trailer Court ❑ <br /> Motel ❑ Other.... .....---------.............. ------- <br /> Number of living units:_._..-- ----_Number of bedrooms.-�- Garbage Grinder N-0--Lot Size.------ _ . _ --.............. ..... . <br /> _.3k -Private <br /> Water Supply: Public System-and name.- ---- <br /> i <br /> Character of soil to a depth of 3 feet: tSand EJ Silt El Clay El "�Peat ❑ Sandy Loom ❑ Clay Loam w <br /> ;T Flardpan ❑ 'Adobe ❑ Fill Material.. .- If yes,type................................ <br /> r k <br /> {Plot plan, showing size of lot, location of:system in relation to wells, buildings#etc. must be plated ori reverse side.) W <br /> - <br /> NEW INSTAL;ATION: (No septic tank or seepage p 'it permitted if public sewer is available within 200 feet,),,,', <br /> .y. I .-._ 1..-, --- <br /> PACKAGE TREATMENT i'( `] #SEPTIC TANK ( ] _ (� Liquid Depth <br /> Ca acit "--...7 e-------------- ------Materia L..----- -- - ......No. Compartments--------------------------------- <br /> u <br /> ._.-- ---- ..�fc-.....v <br /> p y..�. �- Type <br /> Distance to nearest: Well----------------- --......I--------Foundation..---...__ . ..--.-.--....Prop. Line------------ - ------.`...� <br /> -- <br /> LEACHING LINE ( ] A No. of Lines_.--- ----'-----------------Length of each (ins.----.-------------- `-_Total Length <br /> - , Depth Filter Material ---- --------------- - ------------ --------- ----- <br /> D' Sox_......._ _ Ty.pe.Filter Material. Depth � - - <br /> f S r ;t k :..Foundation.--f 4---- ' Property Line..s _. __ <br /> - ---....... - <br /> Depth.. eI 'IIsi 4Well: - I t ' \ A No <br /> SEEPAGE,PlT ( ] Disptance to n. Diameter-------------- <br /> - ----Nu ber-,-.--------.---------------- led Yes ❑ <br /> Rock Filled <br /> Water Table Depth..-.. -.'"^' ...."" . 9 ,s,.e -Rack Size -f <br /> F <br /> nearest- Well--------------- -- <br /> -----••-Foundation. <br /> I -------- ---�--- ---- `-�•�- ��- .....Prop. Line.-: - --- <br /> Distance to ne - -- <br /> REPAIR/ADDITION;JPrev. Sanitation Permit#--------------------------- ------ --- ..........Date._..-------------- <br /> ---.-.-.---- ) <br /> Septic Tank (specify Requirements)....__ _. __ <br /> jz ------=-------------- ....... <br /> Disposal Field Specify Requirements) - 4 �� - - ..1. '._iQ----- (,�..1.-�`1 .- -------;- <br /> ._-..�- -------------•� �J=:»n ------- ------------------------- ............ <br /> ---•-------. �. <br /> (Drove existing and required addition on reverse side) <br /> a <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> r Ordinances, State Laws, and Rules sand Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> 46 <br /> signature certifies the following: l j." "j�� •`- t c <br /> "I certify that in the performance of the work for which this permit is issued,�l shall not employ any person in suchmanner as <br /> ( to become subject oto Workman's Com pLLensation laws of California." <br /> Signed.:-. ` ?-Cir...-- } i ._' ------ ------------- <br /> )J <br /> --------- - `.-Owner <br /> ---- ..- ..... <br /> ' .' .�a1tl:'\--f:-�✓ ./_56.'C�-�'V.- ...............Title-------- --- �--- �r�-L } <br /> BY..............-- <br /> ` •i-c (If-other than owner) <br /> t FOR DEPART NT USE ONLY J1 <br /> APPLICATION ACCEPTED BY............ .. :°f---DATE -----.J------9- <br /> +� <br /> : ---------- <br /> ADDITIONAL <br /> DATE--------- ------y-------- . <br /> O ----- <br /> .: <br /> ! tDIVISION F LAND NUMBER-------------- . - ------ <br /> ADDITIONAL COMMENTS... '-------- ----------------- = <br /> ---- _. <br /> .._.. -••--------------------------- <br /> - F- <br /> f°' -- ----------- ----------------- <br /> '�'`:[ ' <br /> ----------------- ------------ <br /> d .................... <br /> ........... ''. '� ..-Dater ... <br /> Final Inspection by;......... - <br /> ... <br /> r, fps 2ev. /�a 3MEli13 24 SAN JOA IN LOCAL HEALTH DISTRICT <br />