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FOR OFFICE USE: %s" 1%./ <br /> �3i . ... <br /> APPLICATION FOR SANITATION PERMIT ''1/ <br /> Permit No7............... <br /> � ���/1" <br /> (Complete in Triplicate) <br /> .`..... ................................I.....---- <br /> ...................................................................... This Permit Expires 1 Year From Date Issued Date Issued J�........--. -. <br /> LApplication 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 /> fd <br /> JOB ADDRESS/LOCATION ..Io2_�. -.L._,.--..... --..-- �C�� . .. ...... . ......CENSUS TRACT ..................... <br /> Owner's Name ....... -�/�z - ......A. ... Phone .................................... <br /> O :. .. <br /> Address _.__.._..._.l+' -��- .. R >r+t City . . ..... .- .. <br /> ti 0�� Y <br /> ` Contractor's Name ..�xlrrrck�+' - ... ...-.-.License t!t�pf Phone <br /> Installation will serve: Residence❑Apartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other .. <br /> Number of living units:..... ..._, Number of bedrooms _...Garbage Grinder ------------ Lot Size ............................................ <br /> Water Supply: Public System and name ................. ......................-------... - --------------------------------..._------......_...-.Private e <br /> Character of soil to a depth of 3 feet: Sand❑ilt❑ Clay E] Peat❑ Sandy Loam ❑ Clay Loam C1Hardpan 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 seepbge pit permitted ifpublic sewer is available within 200 feet,) <br /> y1J <br /> PACKAGE TREATMENT ( J SEPTIC TANK{ Size-. . -.-.. �f�l.... ..�` i.. .... Liquid Depth ... .....................`� / <br /> - Capacity Ia7��.. .-- . Type �%.- Material..�� ?r �' - No. Compartments A—-2 <br /> Distance ton rest: Well ...-.-----..CEJ-./..............Foundation ...Z,0C...........,Prop. Line -Jam.-•--..-......._.J <br /> i <br /> _ LEACHING LINE J No. of Lines ......a2 ........... Length of each line--_-._._..1�P-. -........ Total Length ---/-47jC:.............. <br /> 'D• Box ..../------ Type Filter Material ...... :..-.Depth Filter Material --.. -------=-------- ----------- rl <br /> Distance to nearest: Well .......-.rp./....- Foundation .......-. -.�-.---- Property Line .--r..- -- <br /> " c .............. Rock Filled Yes No ❑ <br /> _ 5 / �.�t---.---. Number ......... . <br /> SEEPAGE PIT [ I Depth .-¢ter............. Diameter .-- ! �, <br /> �?,.�+47 Rock Size ----� ..ZcQ...... 10 <br /> Water Table Depth ..................r:--- --- <br /> Distance to nearest: Well ......... © <br /> ..........-..........Foundation .--- Prop. Line ... 5-........... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Dote .......................-----------1 <br /> Septic Tank (Specify Requirements) ..................... -------...-....0---_.--.------.-----------_---•-•-•-------•- -----.-..---- <br /> Disposal Field (Specify Requirements) •"•-------------"" 3 <br /> ...............I................ --------------------- ....... - --------•------...-.....---------------- ................-.--................................................... <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 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 subject to Workman's mpensation laws of California:" <br /> Signed .......... ........... •- . - --- Owner <br /> 6 - Title . .k ._.:.. .. ............. .. <br /> By .. - - --- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------- ---------------------••------•• -------- -.----......._........ . -----.... DATE _-71-7 . 2-...---------------- <br /> BUILDING PERMIT ISSUED .. ../.. yf .............. <br /> .. - . .............DATE _.........--...-..._.-.-...-•---...... . . <br /> r ADDITIONAL COMMENTS ... f.,9� .t' -[� k a C1i - .............................................. - <br /> ..................---------- -- - ..-...---.......-.--...-..-------••---.............................. <br /> - ........ . ......... .. --- ---- ------.........----.-...,_----.. - .._......--- --......._.---...--..•------.............................. .....- ................................... <br /> Finalinspectionb ... ........................................ ---- . ....................... •---....-......Date ... 3�--T..-....--.....--...-.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT n, <br />