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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ....... ...�: ...--....:: .. _ - + (Complete in TdpliwNl ... - - permit No. ..7 5.y . <br /> ....... i This'.- -- <br /> This, 1 Yew From Date lsatred Date Issued <br /> t : ) <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 ADDRESSAOCA V- -CZ.. •---. CENSUS TRACT ...............:....:..._ ' <br /> Owner's Name .......(/? .f.. ... ... ................. ...................... ...,:.... Phone .369'1,7?....-_... <br /> Address ............ .... .. '-..� .............................City ...... .. ._..... .. ' ........ . ......................... <br /> 3 <br /> ConNaBor s Name---•................ ...... �` .._.....license 1b�Sy`!? l L <br /> -t.�-.... Phone . :�.d�._..... <br /> installation will serve; Residence j(ApartmentHouseQCommercial Moller Court Qt <br /> // <br /> Motel Other............... ,.. :........ ( <br /> Number of living units:-.----!_..:- Number of bedrooms ..19 Garbage Grinder ... 1.... Lot Size . <br /> t - I�-..�.-..--sou......................:-.. <br /> Water Supply: Public <br /> stem atRf name -r----------•-•...............�..-----•-- --.::...._....-...-..�. .... .... ,.........-.....Pr <br /> Character of soil to a depth of 3 feet:- Sand. <br /> _Silt Cla - <br /> t � -_ L-I � Y=�� -P°°t 0-- Sandy Loam1­1-4 Clay.Loam.Q <br /> Hardpan 0 Adobe 0 Fill Material ...-_.....:-If yes, We............... ............ <br /> (Plot plan, showing-size-of"lot;location-of-system-In -relation to wells, buildings, etc. must be, placed on reverse side.) <br /> NEWINS_ TA_ LLATION: (No septic tank or seepage pit permitted if public sower Is available within 200 feet,) <br /> PACKAGE TREATMENTA { i ' <br /> ( 7 SEPTIC TANK{ 7 Dl ize.....--5..>L- .. Liquid Depth ...4FY.........* -PO <br /> Capacity . . . Type . 3^.... - erial. ----:..... No. Compartments <br /> j _ -..........� <br /> Distance Jo :nearest: WellSQ--Y'•,- • w s <br /> •-•--.... . .-.-.....Fuondation ..--./:t2........... Prop. Une..�.�1!'........� <br /> I <br /> r <br /> LEACHING LINE (� No, of Cinet' - ---..._- Length ofQeach line_ Q i1.....-_.. Total Lengthy ...�(................. <br /> D' Box --..-✓-... Typo Filter Mater cf=-FD s_.,�.DepNf FfIMc{Maaterlal ..... ........._.-.._m <br /> Distance to nearest: Wel► -..SO�.t........ FoundaN �.. 1 <br /> . Sl..,f_.... Property Lina .. ( .........-_ <br /> SEEPAGE PIT Depth ....1S.......... Diameter ` '�` \ Y r �yt <br /> -:.-- Number +..`_-.-.._.-_ ._..... Rock Filled Yes fel t Q <br /> Water Table Depth .................. _.a ... -.....-RocknSL <br /> .Istance to nearest: Well ....... ---7�'...- -`oun!dafton "/.:Q.'t`-1••_. Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit#---------------- .................. Dat6..-:.._t--: _�� <br /> ..-•------- - <br /> Septic Tank (Specify Requirements), ..-----...:. -----•-------•----.....•--._..--. ......................--------------------- . _ _.... <br /> Disposal Field (Specify Requirements) ...._............:-..:.............-.--.... :r. -�--...t-' -,- <br /> _--------- -:......--:...................... - -- <br /> _---� �. _. _ •---- - - _.._........ <br /> _ e.... ....:. ^—..... . <br /> \A 8' ! (Draw existing and r`uired addition onnrreVerselside`1 � ( r <br /> `1 hereby certify that 1 have prepared this application ond`fhof 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 Ilcen- <br /> sed agents signature certifies the following: ` r <br /> i"I certify that In the performance of the work for which this permit is Issuecl,a)shall not oriiploy any person in such manner <br /> s to become subject to Workman's Compensation laws of California." <br /> Signed .....__�_.... .... - --- Owner <br /> ....... <br /> By ............ .1 . ---- - ...................................... itle - / . r , <br /> 11 of than owner) '"' . -..F'Y;-_ti"-". <br /> z : <br /> FOR DEPARTMENT USE ONLY <br /> (APPLICATION ACCEPTED BY .......G' . .......................----------------------------- <br /> ..... -- - DATE .,A G,3_2��..-.. <br /> ---•------ ...._ I <br /> (BUILDING PERMIT ISSUED..................... _ ....._........__.....DATE .... .-...... ......._... <br /> ADDITIONAL COMMENTS .......--.__.---.•-------•---....-- ..---._.__.._._. <br /> ......................... ............. ._. ............... :-.. <br /> - ... ...... .........--.. . - ...... •--...............................___..... - - - ............-.. .................... _.._ <br /> -....-._.-.— - - . ---....- ---------.. <br /> Final Inspection by: __....._---... ' . <br /> --- - --... <br /> - ......................._.-._.-.......----..-..._...._.-...-----'----.-Date ..... .. ... .f,.c'$�.--.....-..... <br /> EH 13 24 1-68 ReV, 5tf SAN JOAQUIN LOCAL HEALTH DISTRICT 8 7h 3M <br /> t <br />