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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT9g09__—r0 <br /> - <br /> ....�. ...............•---........_........_.._.......... ermit No. <br /> 3%j7 <br /> lCoMpleto In trip!#cote) - 6 . <br /> ...-•...............•---------••......•--..._............ 'q } <br /> ......----.•..........-•................................. This Permitfxpires t Year From Dote Issued <br /> S !:. <br /> Date Issued 77 <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. 5.49 and existing Rules and Regulations: <br /> JOB ADDRESS/LO .. -. <br /> TION ..�4f ...,D .R 4Afe. .............. .......CENSUS TRACT C5 <br /> Owner's Name ... .......... ..........r.-..............:... Phone .c;7_.J__.!._ .f_`�.i`i_ <br /> Addresse7�.�.�..�..�----....... ---------------------------•-----------•.CIty�C����-----•-•-•-----------------•----------•--- <br /> Contractor's Name ...CJ&WNE/•-------------------------------------........................License 91i .../ _....._ Phone - .........------ <br /> Installation will.serve: Residence <br /> .,�Apartrnent House 0 Commercial❑Trailer Court ❑ <br /> Motel❑Other....................................... <br /> Number of living units:--1... Number of bedrooms _3----Garbage Grinder ......__ Lot Size ........ ......' __` .`:4.......... <br /> Water Supply: Public System and name ------------•••... ......_......-•-•............._---.............._............------...._........._.Privat <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loan Clay Loam ❑ j <br /> Hardpan❑ Adobe 0 Fill Mcterial ............ If yes,type._........... ............ <br /> Mot 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 available within 200 feet,) <br /> PACKAGE TREATMENT j ] SEPTIC YANK. size-,......fir ...... _ ._ <br /> . -.. LiquidDepth -------- <br /> --------------- <br /> Capacity/070D <br /> ------- --------------- <br /> Capaciry� Q /_---. Type r -C_ _1M �� ri No. .......... <br /> !' <br /> /Compartments ......�......... <br /> Distance to nearest: Well ---------- .................Foundation ....1..4__---_-- Prov. Line_._s 6 <br /> LEACHING LINE [ ) No. of Lines .....4DI............. Length of each iinw. Total LengTn,P;.... ._ <br /> O'D' Box ..... Type Filter Material �..... ...... ..Dept alter Material ........ ...---•.-----.•-----......_ <br /> Distance to nearest: Well ---.ti 7�.-f....... Foundation ...e:O f..._...... Property Line ................ <br /> Depth _----------------- Diameter ................ Number ..._-•--.---_--_--_--- Rock Filled Yes ❑ No ❑ <br /> - Water Table Depth ................................ ...............Rock Size ...... ................... <br /> Distance to nearest: Well ..Foundation ................. Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date .................................. <br /> Septic Tank (Specify Requirements) ...................-..............:.........-..................=..............................................•••-------------•--.._.. <br /> Disposal Field (Specify Requirements) ......:....... ---------- ............................................ -•---•- ...................-.................................. .. <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 dons In, accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.011striN. Home owner or licew <br /> sed agents signature certifies the following: <br /> "1 certify that in the performance of the work for which this permit is Issued, I :half Lt employ any person in such manner <br /> as to becom subEect to o man's C mpensation laws of.,California." <br /> Signed - -6 .. Owner <br /> BY ----------------------------- 't--an owner) <br /> (If othererth •- -•w ------------- -------------••---•------------•- --•--- Title ---•- ......... ................... ............................. <br /> �s <br /> —f'OR ENT SE--ONLY <br /> APPLICATION ACCEPTED BY ... .._.0'!-- - •••. DATE .- .- .- -....---•----- <br /> BUILDING PERMIT ISSUED ----------------------------------•-- .....------. --------.••-••.-•--------------------------------------------- DATE .......................................... <br /> ADDITIONAL COMMENTS - <br /> --------------- -- .. ----- -----.-..-------------------------•----------•- ----------------------------- <br /> -----•---•-------•---- <br /> -------------•------ ------ <br /> Final Inspection by: -•-----• Date . �. <br /> - ------------- -------------- ---------- ------ <br /> 2� -� i SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />