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FOR OFFICE USE': "' �� �_ �� .� �• � �� �� � <br /> ------ - ----------- --------------- ,-- APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. <br /> ----------------------- <br /> ------------------- --------------- This Permit Expires 1 Year From Date Issued Date Issued --- �` <br /> C <br /> j 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 Ordinande No. 549 and existing Rules and Regulations: <br /> i !� C� <br /> JOB ADDRESS/LOCATION .---I872�Pb/V �-Y7_____CENSUS TRACT rr <br /> Owner's Name[. �1V ------ 1g_� l!~N_� _ ----Phone <br /> Address ----- `/------13-0 sf AfA---' '=f ` .Ci '- r-• <br /> .�4LD_q._----------------------•-------------- <br /> Contractor's Name .__.0LVP1 R---------- - -------------------- <br /> ------------ cense # ---��---------------- Phone ---------------------- <br /> Installation will serve: Residence Apartment House-[] Commercial:❑Trailer Court i,Fj <br /> Motel ❑Other ------------- <br /> F r AAtt <br /> Number of living units:__ ------ Number of bedrooms _3------Garbage Grinder IV'-Q__-_ Lot Size / CRl�fa <br /> Water Supply: Public System and name ----------________________ _ _ •_._ <br /> - -__ - ----------- ----------- - ----- •----------------- ---------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;9.1 <br /> r .Hardpan P�'�Adobe.❑_ Fill Material /VV--- If.yes, type ----------------•----- - _-- <br /> (Plot 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,) �I <br /> PACKAGE'TREtiATMENT SEPTIC'TANK• r <br /> f Size-------------------------------------- -------- Liquid Depth ---------------•- �++ <br /> capac`Y ---------•--------- Type -------i•------ --- Material- .' ,No. Compartments _ <br /> Distance o 1narest: Well ---------- ------------- --------Foundation ....'i_-_______------ Prop. Line ------------.:------__ <br /> LEACHING LINE [ ) No. of Lines .--_____-- __-_______ Length of each line______________________--_- Total length <br /> AA D' Box ._____---.- Type Filter Material _____________}______Depth Filter Material <br /> x ............................... <br /> SEEPAGE Distance �to'kr edre'st 1Nekl --------- ----------- Foundation -----------------___--- Property Line ----------•- -- <br /> -----•--- <br /> [ ] Depth Didrmeter ---------------- Number -------------------,5'----- Rock Filled Yes :E] No i❑ <br /> Water Table Depth ____-___--- <br /> Distance to nearest: Well Rock Size pr <br /> I <br /> ------Foundation ------- --------- Prop. Line --•---------------•--- <br /> 1 <br /> `—_-REPAIR/ADDITION(Prev. Sanitation P€m�f '---�--_ --------------------- Date _________________ ___________ <br /> Septic Tank (Specify Requireents) ____________________ `: <br /> --- --------------------------------------------------- <br /> Disposal Field (Specify Requirements! -Am-------�_��_��}[�� ,---��`7�----- ��l�l/V�--_---•--------------- j <br /> !-- <br /> C. �4c1- --i- - �C ►`� -------------------- <br /> • _ - <br /> --- - <br /> ------------------ ---------- <br /> -------------------- --------------------------- ------------------------------------------------------- <br /> ` j w- ! ­6;_.�I(Dcaw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application•Qnd that the work will he done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Redulations of the San Joaquin Local Health District. Home owner or sed agents agents signature certifies the following:_/ F <br /> I certify that in the performance sof the work for �nrhich this`permit is issued, I shall not employ any person in such manner <br /> as to be41s :ject to o kman om nsation`laws of-California." <br /> Si ned - # 1_1{ <br /> Signed " OWner <br /> By ------- I------------------- Title - <br /> ! other than owner! � ------------------------------------------ --------------------------- <br /> FOR <br /> -- -------- ----- ------ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y _I_ � _--____- —� - <br /> - DATE "' � <br /> BUILDING-PERMIT-ISSUED---- e»-....-.-.i.,�...-__ - / - - ---_-- <br /> ADDITIONAL COMMEN757= -_ �_T`--D Q_T -__t-1 b----' 4� t r, _-----A.—K PrTG�JnJ----- i4r-- <br /> ----------------- - <br /> -------------------- <br /> --- ----------- <br /> ----------------A <br /> ..� — <br /> ------------------- --- i <br /> Final Inspe - <br /> ---- ------ --- - - --- ---- --•-------- ------------------------------Date ---- ---.......@-` -7,1- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />