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FOR OFFICE USE: '' iP/cr <br /> APPLICATION f:OR-SANITATION PERMIT �, � <br /> .......I.... ....::'�• ...:... �, _ __ -_ .1Can+p In'.Triplieatel. _ M r Permit <br /> .. ate Issued ..1............... <br /> ?his Permit lExpires l-Year I:e Dah Issued- <br /> Application is hereby made to the gan•Joaq local Health District fo/a.lpermit to construct and install the work herein ! <br /> described. This application is made in,.eompliance with County 10rdinanc6 No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCAJION .. .. / (� <br /> :, / '1 ...CENSUS TRACT <br /> -... ._...j... .....: ............... <br /> Owner's Name ........................._ .-....>.........:........ >.. _ u............... <br /> �' - <br /> -- --.Phone <br /> Address _._.. :. <br /> ..City <br /> Contractor's Name .............. r.............................. ••----------. _....:........License # .......... .....--- Phone -- -------- ,- <br /> Installation will serve: R sidence 0 Apartment House fl Commercial❑Trailer Court 0 , <br /> Motel ❑Other ........:_- ........ <br /> Number of Ervin units--.•'-/ Number of bedrooms Garbage Grinder 4... ------------ <br /> Wates Supply: Public System and name ............. ❑ <br /> - ...----.._ ................._.->-------_----_---•--......>------------•••------- ivate <br /> Character of soil to a depth of 3 feet: Sand te Silt❑ Clay, ❑ Peat❑ Sandy Loam jZ Clay Loam <br /> Hardpan o . Adobe❑ dill Material x If es type :�........... .........••. <br /> (Plot plan, showing size of lot, location of system in relatll*A to wells,tuilding etc. must be placed on reverse side.) <br /> NEW INSTALLATION-. (No septic tank or seepage pit ,permitted if public sewer is available within 200 fest,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ S .. �` i <br /> ] r :. lfT.'.ri...................N -'. �LtquidjDepth .................... ,W <br /> Capacity ................ TY ---- --..... No Compartments <br /> ................._..p Material ... ........ <br /> Distance to nearest.• Well Foundaflon - �1. ....... ('fop. Line . <br /> ..._... ............... ....................'~� <br /> LEACHING LINE <br /> No. of Lines -------- -----•-•--__-- Length rt�f' each line.'. ._ . . Length - r <br /> = 2s D' th�. dt r. Mate otal <br /> D' Box -•• <br /> snlF Type Filter Materialep <br /> , <br /> �T <br /> Distance to nearest Well _._1.. a_ p.._l_. ._.. ri i `s .. � <br /> Foundatio <br /> • •- n ---- operty line ...��. ..i <br /> SEEPAGE PIT [ ) Depth .................... Diameter <br /> --------ki. .............._... <br /> --- --- Rock( Filled Yes jQ, No ❑ {o <br /> Water Table Depth ....__---2.7-- •el-------.--- Rock Size --- -- '� `; ` •- — <br /> K <br /> h p <br /> 'Distance to nearest: Well � .�`::Foundatian :�:::.:..`t:.�_. Prop. <br /> ..Date :" ..: =' ' <br /> REPAIR/ADDlT10N(Prev. Sanitation Permit ..........------------ <br /> --•................... .. .. <br /> Septic Tank (Specify Requirements) - .....--••••----• ......----•-......; ._ : �----== ==------ .._..: j p <br /> Disposal Field (Specify Requirements#�... _:........_. ..f�. !�±- -:•��-• =6y-•-772 g � ,L, <br /> ----...-•--------------............. <br /> -------------------------------••----------.-.-----••-..----------------.. ._....------ ....................------=--• ........................... <br /> ..---............••---......--. <br /> (Draw existing <br /> and re--uired M ddition on reverse side) <br />\\I hereby certify that I have prepares) this application and that the work will -be done In accordance with San Joaquin <br /> .county Ordinances, State Laws, and Rules and Regulations of she San Joaquin Local Health.District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for"which this permit is issued, 1 shall not employ any parson in such manner <br /> as to b comes to man:��n laws of California." <br /> Signed _._._. -- --- <br /> ••-•----------••.......L._.. Owner <br /> BY --------------------------------------------------------- -------------------------------- Title .................. <br /> (If other than owner) <br /> R DI:PARTME T USE ONLY <br /> APPLICATION ACCEPTED B, <br /> •-- ---•---• __.._.. ------ ---------......._.,DATE... :._ __3-- .J7r._._., <br /> BUILDING PERMIT ISSUED .........- --------- ....................... _DATE ---........----.---------_.__------------_- ` <br /> ADDITIONAL COMMENTS --------------••-- } 1 <br /> ------ ......._..--•------------- <br /> ----- <br /> - ......_:__...:-•-------------------- ----- ---._._..-.. <br /> '`' _ =f` ` -`•"fit-. . .sem <br /> - <br /> �­ <br /> EH <br /> . ------•------------- <br /> r. 1 inai Inspection by:• <br /> ................................ ----------• -------Date --- .--.. ...... <br /> .... <br /> 13 2It 1-68 Rev. SAN JOA uIN LOCAL HEALTH DISTRICT 8/74- 3M <br />