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Fj(if 01FICE USE: <br /> APPLICATION FOR SANITATION PERMIT , ,/ <br /> (Complete in Triplicate) Permit No: ...7T....�y <br /> ---------------- ----------___.. This_Pormit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health Districtrfor 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/LOCATION ..-•----- .--..-2 82•__Carpenter..Rd,-- ~~- .._...._.^- CENSUS TRACT ---------------------- <br /> Ch <br /> TOID3Lt' tid l 111a <br /> nrner's Name .......... -.. ----------------5-------------------------------------- ----•------ -------­----------- ----Phone <br /> Address --- a-alpe------------•-------X 4 ------ City -/S tkn-:------------ <br /> Contractor's Name }$ -- -- p --- --- -- -----------------License'# -._2689-Jr'1------ Phone ...46-3*=-7.04.8...... <br /> Installation will serve: 1j Residence❑Apartment House,❑ Commercial E]Trailer Court C] <br /> I Motel ❑Other - -------------- -....._. � <br /> j � F � <br /> Number of living units:--- Number of bedrooms ... .5-..-_Garbage Grinder :..., -- Lot Size ..... _.. <br /> ..........1Aes _._ <br /> .___ ..._.. <br /> ' <br /> Water Supply: Public System and name'------------------------ - •------. -- - �. ----------------------------------------Private <br /> Ja <br /> Character of soil to a depth of 3 fee Sand Silt[j Clay ❑ Peat❑ -Sendy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ '.Adobe E] Fill Material ............. If yes,type -------------------------- <br /> (Plot, <br /> -_ <br /> (Plot tIan showiri" y _ <br /> p g size of lot lo_cation of s stem in reldtionto 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,) <br /> PACKAGE TREATMENT •[ Al <br /> J SEPTIC WA Kf[ ] Size-.!:-... _`__..,,.........___,.............. Liquid Depth ..._..____.__ <br /> Ir <br /> ` Capacity - "------ --------- Type ------------ - Material•-- ...------- d No.. Compartments ---- -. -- �r <br /> Distance to nearest: Well ............. ......................Foundation =__- -------------'r.- Prop. Line_____-.•-.__.:-.___..-/" <br /> LEACHING LINE Pq No. of Lines 1 -------------------- Length of each line...:._9�...-..__....._-. Total Length .....9d_................... <br /> 'D' Box1..__..__ - Type Filter Material --------2'!---------Depth Filter Material ------- �,�*'________________________ ft <br /> ' �: ` # <br /> Distance_to_nearest _Well._-...--.-8Q..._.._..<Foundation._.. _.. ... Q................ <br /> •--•- --•-- Property Line. ..---..SEEPAGE PIT ! <br /> [ j Depth __ ----------------- Diameter _..------------- Number ---------------- ........... Rock Filled Yes ❑• J No <br /> Water Table Depth .................... ...........................Rock Size .--' -------•-------••-•---•-- p <br /> F " Distance to nearest: Well .............�.-------------------...__Foundation Prop. Line ........._..-_._ ,,3 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .....-..-------4' .. ........... Date --------A g.._..72__.._._) <br /> ` Septic Tank (Specify Requirements) ----------- - -------- . -•------------ - ---- <br /> Disposal Field (Specify Requirements) d Lea-c-h 1A 1e----------------------------- <br /> ------------------------ 1 <br /> .................. ----------•------------------- -------­----ry <br /> A , <br /> ------------`-• -------- ----- =---------•---•----•-•-•-•-------- <br /> (Draw existing and required addition on reverse side) t e* <br /> I hereby certify that 1 have prepared'iV appll'Eatioie ana-ti —ai tiie work will be—done in accordance with Sart Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Disirict. Flom* owner or licen- <br /> sed agents signature certifies the following: <br /> "l certify that in the performance of the work 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 /> ---,-- •. --•---`-• --•----•-----•---- r <br /> BY -.!.. ----------------• -------- Title .------.Contractor. <br /> other than•awnerj ; <br /> 'r- FOR DEPARTMENT VSE ONLY <br /> APPLICATION ACCEPTED BY r UVII- ••_ . i •------------------------------ <br /> A. _ -._ E.......................... . ._...BUILJfNG..PERMIT..ISSUED ... TE. . .ADDITIONAL COMMENTS --------------------- <br /> -­--------------- <br /> I4I <br /> ----- ----------•-•-----•---------..-..-----•--------- <br /> --•----•--••-•............................................... --------•------ ------•---- •-•------------•---------------------•-----------••------••• ----------------"-••••--•---- ------------ <br /> -----.... •----------•--•----- ---•---- -------------------------1-•-•---•-------•----•- •--•---------- -------- <br /> - - -------- <br /> Final Inspection by: ...•.___-•- •-. Date Ti ----------- <br /> - --- -� -- <br /> SAN JOAQUIN 6 AL HEALTH DISTRICT / f <br /> E. H. 9 1-'b8 Rev. 3M ,I <br />