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a <<FOR OFFICE USE: ` APPLICATION FOR SANITATION PERMIT <br /> r --------------------------- Permit No. <br /> - (Complete in Trip licatel <br /> _________________________________ <br /> ---------_-----.--- This Permit Expires 1 Year From Date Issued Date Issued <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/LOCATION- _�s t6-�7 L _--�-------II N_�---RD- -------------------------CENSUS TRACT ___ ------- <br /> Owner's Name -_ � �n-L- �: Phone <br /> -----------� <br /> Address - I�4/fy. ----- '� J -- 1 F- =-_----------•--. City .---------------------------------------------------- <br /> Contractor's Name ------------------­__­---.License # -------_--------------- Phone ---------------------•----- <br /> Installation will serve: Residence {Apartment-House-❑ Commercial [:]Trailer Court f]Motel ❑IOther ------------------ ------------ -- ------- <br /> V1 <br /> Number of living units:----- ----- Number of bedrooms/_Garbage Grinder __ ._. Lot Size __ MFFM� ------•------ <br /> Water Supply: Public System and name ---------- ---------; -------------------------------------- -------------------- --------- ----------Private ©� <br /> Character of soil to a depth of 3 feet: Sand'C !%Silty Clay ..E] Peat ❑ Sandy Loam • Clay Loam 1:1 <br /> 41 <br /> Hardpan Eb �' �❑ cil'>._ _ .Q--- If yes, type -------- ------------------- <br /> � Adobe .`Fill Mater: <br /> (Plot plan, showing size of lot; -location­ system in reEation to wells, buildings, tc. must be placed on reverse side.) <br /> t <br /> NEW INSTALLATION: (No septic tank or ee0age pit permittee[ if public sewer is a ailable within 200 feet,) V <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' - Size L--- '`------------- ------------ Liquid Depth -------------------------- <br /> Capacity ---------------- -- Type -------------------- Material -`---------- ---- --- No. Compartments -------- ---- <br /> Distance to neares Well -------- =-----------= ------Foundation -------:-- --- Prop. Line ----------..---------- <br /> LEACHING LINE ( ] No. of Lines ---------- ------------- Length-of'eaclifl ne------____________ _________ Total Length ,_____.________..__________- <br /> 'D' Box ____......- Typ Filter Material --------------------Deptli,Filte Material --------------------•----------------------- <br /> Distance to nearest: ell -------------------';._ Foundation .: --- --- ------------ Property Line ------------------------ v <br /> SEEPAGE PIT [ ] Depth ___________________ Diameter __________--- _ Number')_.__-_�_�--- ______.___ Rock f illed Yes [] No <br /> 41 <br /> Water Table Depth ------------------------------------------------Rock Szei--- -----------------------_--- <br /> I -.. <br /> l ._D.is�tance to,nearest: ell .---------------------------------------Foundatio- -------------- Prop. Line ---------- ----------- <br /> REPAIR/ADDITION(Prev. Sdnitation Permit# - ------- -_- -y-------------Date _____________} <br /> Septic Tank (Specify Requirements) ---- --- --- ----------------------------------------------------r ", - ------ -------------=- --:------------•-----------•- <br /> i <br /> Disposal Field (Specify Requirements) iQx - ---------- - <br /> -----------------------44�4 e--H--------I-11 E------------------------------------------------------- ------- U--=-=-------n-_---------------------------...----------------------- <br /> -11 1 i 0 4 ' <br /> (Draw existing and required-addition on reve'6e`side) ' <br /> I hereby certify that I have prepared this application and.that the worVwiff be' done) in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin'Local Health District. kome owner or licen- <br /> sed agents signature certifies the following: C <br /> "I certify that in the performance of the work for hick this permit is issued, i `s all not employ any person in Such manner <br /> as to bee e- ub e o an's Co ens laws of California." i t <br /> Signed -- .............................. <br /> ------ --------------------- Owner' I <br /> ------ Title ---- ----- -- -----;-----------'---------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY 1 <br /> APPLICATION ACCEPTED BY ----- TTR42,_------------------------------------------------------------------------ DATE _.~/��-�.����------------- <br /> BUILDING-PERMIT--ISSUED n = =" -= = _ .�.".- __:___ -____._.___.- - - --_- t ---DATE :____ .. _ = W=--y--------------- <br /> - ---------- - <br /> ADDITIONALCOMMENTS ------------ - __ �_�._� .__ _'- -- .`� ::j---------------------------------------------=-------- ------------------ <br /> -- <br /> ---------- -------------------------------------------------- <br /> ---------- <br /> -- - --- ------------------ <br /> I _ --P . _ [� 1a -- - - zai—� --- -------------------------------------- <br /> - - <br /> - - -- - --- ---- --- <br /> Final Inspectio -bY: --- � �� Date 1.. f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E- H. 9 1-'68 Rev. 5M i r, Ro <br />