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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> -v------------ Permit No. .�.�.: {�� <br /> � <br /> F_ (Complete in Triplicate) <br /> 1 <br /> ---------------------____----____________________- .. �, - <br /> � Date Issued <br /> --------------- This Permit Expires 1 Year From 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. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOC TION ._t -O /-----t----�------C---- - -----------------CENSUS TRACT -------------------------- <br /> Owner's <br /> ---------- ----- -69 <br /> Owner's Name -- -fo- d5g------------------------------------------------------Phone_--0-.3 -------- <br /> I <br /> Address _ _ __ -_ <br /> - �r ----------- City G, 4 <br /> Contractor's Name: - '� e� -- ' s -- ' c -- <br /> �/ _ License # �i'1Q._. `---___-_- Phone - - <br /> Installation will serve: I' Residence IM Apartment House❑ Com merciai Trailer Court <br /> ------------ <br /> Number of living units:---�E------ Numberofbedrooms _. _____Garbag� Grinder------------ Lot Size 9 _x---z_ -----------•. <br /> I <br /> Water Supply: Public System and name --C L__ ------------- ------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: ,Sand E] Silt Or, Clay ❑ Peat❑, Sandy Loam ❑ Clay Loam:❑ <br /> Hardpan ❑ , dobe Pill Material ---- If yes, type ---------------------------- <br /> l-A 4 <br /> b �T <br /> (Piot plan, showing size of lot, location of systemTinkrelation to wells, buildings, etc, must be placed on reverse side.) <br /> I <br />' NEW INSTALLATION: (No septic tank or seepage pit permitted if public se4aer is available within 200 feet,) <br /> .117* <. <br /> PACKAGE TREATMENT TIC;TANK-'[ j ,.�� Size------------------------- -_-------.-- --- -_-- Liquid Depth -------------------------- <br /> t _ --- No. Compartments <br /> ---------------_----- <br /> Capacity" � <br /> ---- Type--------------------- Material------- P <br /> to lare�st: Well I-----------------------------------Found ation ---------------------- Prop. Line ---------._._-------- <br /> LEACHING LINE No. of, { A <br /> i sta nc <br /> [ ] }Lil es � + - Length of each line....--_ __ Total Length d_ __________•__ <br /> `D' Box _&_--•-Type F IteriMaterial _ A� y_Depth Filter Material ---/*-�____ <br /> -------------------------- <br /> Distance to nearest: Wellle-te <br /> ��------------ Foundation ------/_0 Property Line. -�.____.__.__._.__. <br /> SEEPAGE PIT [ ] Depth _;(a---- ___ Diar� lUMe-r _ A/ ---------- Rock Filled Yes No <br /> r - *' ss�f <br /> Water Table Depth ----- - ---=--------Roeck Size -- - -�---------------- <br /> a <br /> Distance to nearest: Well --------------------------------------Fo'indlion --- -- ----- Prop. Lime -4 _------ <br /> r s S <br /> REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Dated_._~___-_'_t_______._...____) <br /> i <br /> Septic Tank (Specify Requirements) ----------------------------------- ;,R --------------------------- <br /> --------------------..-,.-------------------------••- <br /> Disposal Field (Specify Requirements) ---------------------------•-•••----------------------------------------`- --- - - - - -------------------------------------- <br /> _ ___ _ __ _ _ ------ ___-________y___-.__ _----------------- -._________________________.___-.____-.____________-________ <br /> '_______________________________________________________________ _ ___ __________ - ---------------- ------- <br /> -_--___ ________________1________________-_____-_-_----_- _._.__.________ .___-_ <br /> (D'raw existingrarnd required,Faddition on`reverse side) <br /> I hereby certify that I have preparedIthis applicatione and that the work will be done in accordance with San Joaquin <br /> ` County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "1 certify that in the performance'of the work for which this permit Jissued, I shall not employ any person in such manner <br /> as to bec a"sub'sct t�o,W�orkman's Jompensation laws of California.' <br /> Signed'if F�-Owner <br /> { BY --------- ----------------- --------------- Title -}-----------------'--------------------------- <br /> --------------------- <br /> i (If other than owner) <br /> I F DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _--- `- - DATE =l' V <br /> i BUILDING PERMIT ISSUED -------------- ---- - --- - --- --- - - --------------------------- -- DATE ------------------- <br /> ADDITIONAL_CrOM TSI S ____-_ ---� _ ------ <br /> tf ;37 r J 3 } ------ -- ----------­--------- <br /> ------------- <br /> --------------------------- <br /> ----------- .` --------------------------------------------- <br /> -Y <br /> u .--" ,., <br /> ----- ------ ---------- ---- -- - -- ---------------------------------------------------------------------------------- -------- / <br /> k Final Inspection by: -------- ---- --- �' ----------------------------------------------------------------------------Date = '!' p--._-._----`------ <br /> I / ,SCAN JOAQUIN LOCAL HEALTH DISTRICT i <br /> E. H. 9 ` '1-'68 Rev..5 ,�/ <br />