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F R OFFICE USE: <br /> APPLICATION FOR"SANITATION 'PERMIT <br /> ' ° Permit No. �J �_ <br /> ------------- - -------------------- <br /> (Complete in Triplicate) <br /> ----------I-------------------------------- ------------ � <br /> ______---------_---- ------------------------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued 1���.___��__9 <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 ADDRESSfLOCATION ._- -_. '_._. _CENSUS TRACT --------- <br /> -- --- - -------- ---- -------------=-------------- <br /> # y/,�-SSS <br /> - - - ------ ----- <br /> Owner's Name_r ---------------- - - ------ ---- Phone t <br /> Address / •-. City s� �• `Y-�C-_ 3d <br /> --�L --------------- <br /> Contractor's Name ' _ &51;0 <br /> -- �_ _ •�-� L__�'�.__-- --.License # �_`��_�J.�.�---- Phone ���------------------- <br /> Installation will serve: Residence>(Apartment House-[] Commercial ;[]Trailer Court i❑ <br /> or <br /> Motel F]Other -------------------------------------------- <br /> Number <br /> ----------------------------------- --Number of living units:----- Number of be`drrooms __-_ ___Garbage Grinder ___________-Lot Size __ " _,_____ _____46 <br /> Water Supply: Public System and name _ L- _ ----------------------------------------- -`----------__--.---..-----___Private ❑ <br /> Y5 <br /> Character of soil to a depth of 3 feet: Sand'I] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan',[:] Adobe�Fill Material ------------ If yes, type ____________________________ <br /> r <br /> (Pl'ot plan, showing size of dot, location-of system in relation to wells, buildings, etc. must be placed on reverse side.)10 r <br /> � <br /> NEW INSTALLATION: (No:-septic, tanO'or seep ge pit permitted if public sewer is available within 200 feet,j f <br /> ;~ I ,t f <br /> PACKAGE TREATMENT f,� -SEPTIC.TANK' Size_' -�� �________________-_ Liquid Depth __ ____ <br /> _ _______.____-._.. <br /> e <br /> Capacity _ __Q_,___ Typ ________ _ _ Material- -__-_ No. Compartments __ __.___�__..._. <br /> 'Distance to nearest: Well ' ______________Founds#ions --_____ Prop. Line . f_____ <br /> LEACHING LINE o. of Lines ------- ._____s.__ Length of each line-3. 1e----------------- Total Length _______________ <br /> D' Box ------------ Type Filter Material !�; 4,_Depth Filter Material -----/- ---------------------------- <br /> ----------- <br /> 'Distance <br /> ----------------•--_ '-___:_ <br /> Distance to nearest: Well _� P- ____ Foundation <br /> ------------- Property Line. - ---- isr-= <br /> I eo /' <br /> SEEPAGE PIT' Depth __��_______ Diameter � ------- Number ------f------- Rock Filled Ye :No 0 <br /> R: x-"k �� <br /> Water Table Depth <br /> l- ---,-----�--/--------------------Rock Size ---f----- <br /> ________ <br /> Distance to nearest: Wel !___________________Foundation __/0?40_______ <br /> 1 <br /> Prop. Line _._ .._......:... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------- Date ----______________________________j <br /> Septic Tank {Specify Requirements) - =--------- -------------------------- ------- ----------•------------ ----r--------------------------- <br /> Disposal _Field (Specify Requirements) ----------- ----------------------------------------------------------------- <br /> ----------------- ----------- <br /> ------------------------------------------ ------------------------- <br /> ----------- --------- --- ---- ---------- - -- - <br /> � � ¢_ .�.... ,�....-— — is i <br /> ----—— ——— —— ———— ——— ---—--—---—--—----—--—--—-------——-------- — -------------- ----------—------——------------------------- <br /> (Draw existing and required addition on reverse side) i <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ord irian_ces,)State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner orlicen- <br /> sed agents signature certifies the following: F—! # e <br /> "I certify that in the performance of the work for which this rmit is issued, I shall not employ any person in such manner <br /> as to be a jeFtt Wor an's Coinpe ati.on laws'of California." <br /> Signed -------------- ----- -- � ,-- ------- -'---------- Owner p <br /> _ I <br /> BY --.._..--�- ------ ---- -- - ------�--------' ------- Title,----------------- ---- - �.. . <br /> --- ----- -------------------- ------------------------------------------------ <br /> (lf other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE ��/IAK <br /> ----- ----------------- <br /> BUILDING PERMIT ISSUED -------- -- ---- r -- -DATE -----r---s-- -------- <br /> NIS <br /> -- <br /> AD I71Q COMMEN S -to.A: ------Q � - g <br /> ----------- - <br /> - ---------� --3--- _ , <br /> ` t 3 _ <br /> , . ----------- -------—--—------——---------------------------------- ------------------------------------------_— <br /> __-____.____..____________________ ___ __ ---- <br /> ----------------------------------------------- <br /> ---__-_--_ _ - <br /> _ ___ ___ ________ _______________________________________________________________ <br /> Final Inspection by. - t, ,0a. . . .�. .+ ` ' ..Date <br /> ------------------------------------------- -- n---- - -- -- <br /> f -' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />