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-- APPLICATION FOR SANITATION PET <br /> F <br /> Permit No. .7�._~�_�-3(Complete In Triplicate) <br /> - •------------- <br /> - This Permit Expires 1 Year from Date Issued Date Issued -_�_���_ <br /> F 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 /> .SOB ADDRESS/LOC TION --L � �..----- _. , . � " _ _.--..-- CENSUS TRACT ......... ................ <br /> t Owner's Name . . M fr-.�...� a✓� ------- ................. Phone . .... ------ <br /> _.._.._._. . <br /> Address .... City ... ..........—.. <br />' Contractor's Name ------.-- - -'�``` � __-� _ '- _ !� ' _ <br /> License # .� C� .c ____... Phone _•-------------•-------•--_--- <br /> Instal(ation will serve: Residence Apartment House 01 ommercial OTraller Court Q ` <br /> Motel ❑Other -------- -----------_....... .........•--- <br /> Number of living units=------------ Number of bedrooms --------....Garbage Grinder __.--------- Lot Size ........-...... ----_- <br /> i Water Supply: Public System and name --------------------------------------------------------Y............ ------__ -- --Private 0 � <br /> Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay ❑ Peat❑ Sandy loam ❑ Clay Loam ❑ <br /> Hardpan LJ Adobe ❑ Fill Material ............If yes,type ............... ...... .... <br /> J1 (Plot pian, showing :size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse sida.)v <br /> NEW INSTALLATION: (No septic tank or see ge pit permitted if public sewer is available within 240 feet,) . <br /> PACKAGE TREATMENT [ ] SEPTIC TANK 5ize._S_�► 1�.�.X.�`,.....- __ Liquid. Depth ...... <br /> Capacity _I �jType •f_­W�4�Material. ' .-.- No. .Compartmen#s ..:_. <br /> Distance,to nearest: Well ......... Foundation __... ' ___ Prop. Line ----.V_ --..--..- <br /> LEACHING LINE [7, No. of Lines -------- ------------ Length of each line------- p. ....: Total Length --- . ......... <br /> D' Box ----I------ Type Fitter Material -----S_j-f-------Depth Filter Material ..-_.- -5._`_ -.--.------ <br /> Distance to nearest; Well --- I..V: _/-r-_ Foundation ------1_G'P11"------ Property Line .- ----------- <br /> F SEEPAGE PIT )!'� Depth Diclrrtieter --------- Number ---------3-----_----_- Rock Filled Yes No Q <br /> Water Table 'Depth --------------j."_ <br /> ..................RccIC Size �F Distance to nearest: Wet#---------1-iv• `-------------Foundation --._1 a" -- Prop. Line __ ,--.----- <br /> REPAIR/ADDITION(Prey. Sanitation Permit# -.------------------------------------------ Date ------.-----------.---------_--_--) <br /> SepticTank (Specify Requirements) --- ------------------------------------------- ------- ----------•- -----------------•--•----------•---•-----•-- -------.----. ---- <br /> • " . Disposal Field (Specify Requirements) -------------•--------------•-------=-----••-----------•--• -•---•-----------------------------•-------- ---------• ---•------------- <br /> ----------------------------------------------- - -------------------------------------•-------------------•-------------=----------------••------•--•-----------_- ----------------=------- <br /> F --------------------------4----------------------- <br /> - - .................................................. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done inaccordance with San Joaquin <br /> County Ordinances, State Laws, and Ryles and Regulations of the San Joaquin Local Health.District. Ham* owner or (ken- <br /> sed agents signature certifies the following: � <br /> "I certify that in the performance of the w4ri for which this permit Is issued, I shall, not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------- -------- Owner <br /> -- ----- --- ---------- ---- - --- Title �� — 'cif_- --------------------•---------- <br /> BY E _05_ �7 <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---C------- ------ --- -----------------..._----•------- -- `� --------= <br /> DATE .. ". ~- <br /> iBUILDING PERMIT ISSUED ------. ------ ----_----------------------------- ------ ------DATE _--- .._-.-.-_. <br /> ADDITIONAL COMMENTS ---- -- -------------•---------- - <br /> ------ <br /> ----- ------------------------------------- ---------------------------- ---• --------------------- - --------- ---------------------------------- --------"--- ----------- <br /> - ---- ------------ ------------------- <br /> Final Inspection by: -------e-r -- --------.Rate ..K-2-. :` <br /> EH 13 2h 1-58 itev• 5m q 0 SAN JOAQUIN LOCAL HEALTH DISTRICT 6/7h jM <br /> F <br />