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r <br />t. <br />I <br />FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />- -------------------------- Permit No. _7_2-_-__(1.Z ..L <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued Date Issued ..lpc..7..:.... �! <br />_---------------------------_---- <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 compliancie with County Ordinance No. 549 and existing Rules and Regulations: <br />JOB ADDRESS/LOCATION .....2-3 5�r ---- --- <br />v�'-'- --................--------------..._----------------------.... Phone <br />Address IiC�..- .----- City .l l fd'� ......................1� <br />Contractor's Name .... Zz tff-j /-25 1,z Z4 C- <br />............... ...._.--------- License _7. I1...4.__ Phoned.f ---- ----.--- <br />Installation will serve: Residence ❑ Apartment House ❑ Commercial []Trailer Court :❑ <br />Motel ❑ Other -------�- ---- ----- ------------------ ,� <br />Number of living units: ..__.----- Number of bedrooms ..,F.,r_....Garbage Grinder __..._ Lot Size _� ..%!�r ........................... <br />Water Supply: Public System and name ------------- ..............................------------------------- --............ --------------------- Private W <br />Character of soil to a depth of 3 feet: Sand R Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br />Hardpan ❑ Adobe ❑ Fill Material .___.__--_ If yes, type ..............____._-.._ <br />(Plot plan, showing size of lot, location of system in relation to 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,) t, <br />PACKAGE TREATMENT [ ] SEPTIC TANK.i ] Size .... ................. ..........._.._..._------ Liquid Depth -------------------------- t <br />LEACHING LINE [ ] <br />SEEPAGE PIT [ j <br />Capacity Type <br />Distance to nearest: Well <br />No. of Lines ....................... <br />'D' Box -------- --- Type Filter <br />Distance to nearest: Well .. <br />Depth ---------------- ._. Diam$ <br />Water Table Depth <br />Distance to nearest: <br />ll......_. Material <br />Igth of each line <br />terial ------------- - --- <br />--------------- FoundI <br />---------------- Nu be <br />No. Compartments <br />________________ Prop. Line <br />.._ Total Length ----- <br />th Filter Material ............... ...... <br />Property Line .. <br />------------- --------- ..... Rock Filled Yes ❑ <br />Size <br />.................... Prop. Line <br />No i❑ <br />REPAIR/ADDITION (Prev. Sanitation Permit #./....................................'..... Date _..__.__------------_...__......_- <br />SepticTank (Specify Requirements) -----------c...............----------------------------------------------------------- .._.._-------------------- .......... .------ <br />Disposal Fieelldl [Spec--------- <br />ST <br />iiffyy/f/Requirements) ...yp.........-.---, ------------------------.-- - /}----------. --- -- -- F/, �../....-..--.----.- /�{/ <br />._.........� S -...__�_7.._.._..�--4J�_� .-__/-"�..iY� ---- -tel-.rte-------. �.�///l.': .._: ���.jl..�'�.--`-_`.._ <br />---------------------------------------------------------------------------q---...------------------- / <br />(Draw existingand required addition on reverse side) <br />I hereby certify that I have prepared this application 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 />"I 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 subjeSj to Wo an's Compensation laws of California." <br />Signed .. -.._ �__.._ _ Owner <br />------ ----------- <br />i <br />By- .... = `----- :. ..... - -'f' - -- Title -- - - - ------- - -- ---- - <br />(If other than owner <br />FOR DEPARTMENT USE ONLY / <br />APPLICATION ACCEPTED BY - t-'.Rri---------------------------------------------------------------------. DATE._6.--In 7Z . --- <br />BUILDING PERMIT ISSUED ----- .._.._......__...__...._.___DATE -_....._._.._.----_ _ <br />ADDITIONALCOMMENTS -------- --------e _ -- --A------- 1 ^-----------------------..:....------------------------------ ----------­-­-------------- ------ <br />Final <br />SAN <br />-- --- --- ---------Date ._ <br />--- <br />I tji3Nl1 <br />