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FOR OFFICE USE: a <br /> r <br /> APPLICATION FOR SANITATION PERMIT —� <br /> _ .s----- ----- ---- <br /> (Complete in Triplicate) Permit No: - <br /> --- ------- <br /> This Permit Expires 1 Year From Date Issued Date Issued -Z-- _-7v <br /> I <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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />! J013 ADDRESS/LOCATI N __---I_----2_(_- ---��-------�R 1 -�------- ------ ----- -- CENSUS TRACTSO-...---- <br /> �_ - <br /> Owner'.s Name ----------- �, .`tii t. !`ic�' ' [ -QQ.i4 -------------------Phone Address _ - , /4�TN� - ----------. City -{--a-�- � <br /> F Contractor's Name a ----fes --------------------------License # ---------:-------------- Phone ------------ <br /> __ <br /> Installation will serve: Residence# Apartment House,(] Commercial 0i6aY1er Court ',❑ <br /> Mot6l ❑ Other ------------------- - � <br /> Numberof living units:---- Number of, bedrooms _ <br /> ----_Garbage Grinder Lot Size <br /> Water S 6 pply: Public System and name -----1----_--___-_-_-_ ✓� Private <br /> ------------------- ------------ -- --- <br /> Character of sol! to a depth of 3 feet: 5and`❑ ryt❑ Clay ❑ Peat❑ Sandy LoamClay Loam ❑ <br /> `I <br /> Hard an Ad-0 _., <br /> Hardpan C� ❑�Fifl MafI t-yes 1we ___--_ <br /> (Plot plan, showing size of lot, location of systernn relation to wei Is, buildings, etc. ml st be placed on ,reverse side.) <br /> NEW INSTALLATION: (No septicttank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TA K'[ ] Size---------- ----------------------- ------ -i-- <br /> Liquid Depth -A ------------------•-- <br /> I Capacity?i TYPe ;- ---- - Mater.ta-Imo--.- -- -- o. Co Ilk <br /> -------••----_-- <br /> f <br /> Distance t o rest: Well '' V'� ------Foundatib ------------- Prop. Line'.---------------------- � i <br /> LEACHING LINE k,. ! __ F Total Length _---- ---- -._ �I <br /> Li: - ---------------- Length of each line ----x--- <br /> - -------------- <br /> No� of L� Ype ner Material _-�----___1__-___Depth Filter rM erial ----- ------ ----- <br /> �. ., <br /> k. <br /> Disptance to nea est: Well ------------------ Foundation ------- - n}~�-- --- Property Lime -3-___--------_------ -- <br /> SEEPAGE PIT [ ] Depth Diameter - = �_- Number ----------- ------- -- Rock Filled <br /> i thy; ( �.<:'c1V ,i,Yei ❑ No 1❑ <br /> ---- <br /> t ( dater Table pth ---a t 1 ! F <br /> 'V i i <br /> r <br /> �. _ ,- Rock Size ------------ 4 <br /> I <br /> T i z a d------ <br /> istance to, t: Wel --------------------- -----------I-----Foundation -_-- - -- - ---- Prop. ;ne I_. <br /> 1 ------•----------- <br /> REPDDITION(Prev. Sanitation Pe t# ------__._---_-___-_- -_ <br /> -------------- ----I <br /> -r Date ------------------- �------------) <br /> Septic',Tank (Specify R4quirements) -- -----_:----_I--------------------------- <br /> { { ... ) tr - .------ ---------------------- <br /> iksposal Field (Specif"f Requements) ---------3 ----------- �+' � f--- AC ) <br /> pT(-------PAM-� - -t1 �,+�-- <br /> _- = ----------------------1- <br /> �- <br /> { raw existi,, ; =-- = :-_ - <br /> e side) 'T <br /> I hereby certify th+;rt, 1`14iZe prepared this application and that the work will be done in accordance with Son Joaquin [ <br /> r--...i <br /> County Ordinancdsy�Std'te. Laws, and Rules and Regulations of the San Joaquin Local Health District Hame owner or licen- <br /> sed agents signature certifies the following: ! <br /> "i certify at in the xe-orman-ce•ci,Vthe work for whicWthis permit is issued, i shall not employ anylperson in(such manner <br /> as to1be subjegt orkman's Co pensation laws df California. <br /> t c,� <br /> Signe "f 1 Owner : <br /> 1 <br /> -- - ---------------- <br /> BY `---------- <br /> . -------------- Title ` ------ <br /> (If other than owner) i <br /> vi r�i k rFQR r EPARTMENTYUSE -ONLY, 4 <br /> APPLICATION-_ACCEPT-ED-.BY .-----4C-- __ <br /> BUILDING PERMIT ISSUED ------------ ---------- ------DATE --------------- <br /> -----------------------------------------------------------------=-------- <br /> T ONAL COMMENTS - -- - ---------------------------- <br /> -- -- -- ------------------------------- <br /> ---------------------------- <br /> -- - <br /> = - _ _-- ------------------------ } <br /> --- <br /> --- <br /> -- ------- -- ------ - <br /> Final Inspec <br /> ---- -Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E, H. 9 1-'68 Rev. 5M <br />