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r6 IFOR OFFICE'USE: APPLICATION FOR SANITATION PEWVATa*'.-,; o y <br /> .................. . .._................................ Permit No. . f:..�..... <br /> '' (Complete In Triplicate) <br /> ------- -------- ------- --------........... - Date Issued ""Z�.:.1� <br /> -------------------.....""_,-"_,"_------------_- This permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit t6 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.77-.. -- �N ------1 -- - CENSUS TRACT ... .:--,S�---- <br /> aA.NzL-675!.U1 f �S �. 1N... .................................Phone ------------------------- <br /> Owner's Name ... y <br /> Address "....�.]t?aQ. y�F .r —City .-R --- r---- --'-------- - <br /> Contractor's Name . ..""l7-NTl'1' of-y--L "'--S�-N.----------=------License#/,6-.X0.6---- Phone <br /> ry <br /> Installation will serve: Residence ❑Apartment House,[]iCommercialxrailer Court <br /> OI <br /> �Nlotel F-1Other RDMA_-QFF1.r-i=""-FRCP f}NS f on/ <br /> T Jl , �� <br /> Number of living units:...= Nuinber;of bedrooms —"...Garbage Grinder ..........-. Lot$ize ..-�CR���------------ <br /> v`ial 0 .s � - <br /> Water Supply: Public System and name ----- ------ ""._...... 1 ------------- --------Private, <br /> Character of soil to a depth of 3 feet:.., Sand El Silt n' Clay ❑ Peat❑ Sandy Loam,AN Clay Loam E]ipa dpan ❑ Adobe 0 FIII:Material . . . _ If yes,type ............................ <br /> J — <br /> (Plot plan, showing size of lot, location of system in ,elation to.-wells, buildings, etc. must be placed on reverse side.) \ <br /> ' E V <br /> NEW INSTALLATION: (No septic tank`or seepage pit'permitiediif public sewer is available within 200 feet,) 0 <br /> � r <br /> PACKAGE TREATMENT [ ] SEPTIC TANK�j Size----7--- x-"� Liquid Depth ......................--- q <br /> Capacity .4.0TypeP)-iECAs� MaterialaNCRI�,No. Compartments ......."- <br /> ! C <br /> ' Distance to nearest: Well __.~1".©.�.....,-1.............Foundation ..0 Prop. Line ....5.. ".... �' <br /> r <br /> LEACHING LINE No. of Lines ...._ :..�.:_. Length„of�jeach line...f�il�.....-"....-_-. Total Length ,_""" ....-.."... <br /> D' Box Fes?. Type Filter Materialdh04 . _ -Depth Fil�iliiter Material -__--.�.0_��- -T------------- <br /> Distance to nearest: Well __ ------_::Foundation _ 0...........t._ Property Line .. .....` ....-. <br /> SEEPAGE PIT Depth "� ' "- Rock Filled Yes No <br /> [ ) p .--.- Diameter..".-.-..------ Numher .,.._��_�__:._'_-- -- � <br /> Water Table 6epth ------------ _ ;:`_'.............Rock Size ----':.......... <br /> Distance to nearest: Well ....................................... Foundation . ............... Prop. Line ...."."..._..-_.__ <br /> /REPAIR/ADDITION(Prev. Sanitation Permit# .........."t`....-r i -� <br /> - ..--- ---Date _ ._ 0 <br /> -_.... _�_:"...............) D i� <br /> Septic Tank (Specify Requirements) . �s� /�.�.- - -�'s- ---.. PG D.....�—..V_rf <br /> YL + / <br /> Disposal Field (Specify Requirements) .h.��Gl'�.---�/..��5..........3,6........Wl.p4 F_ ...-......................................-. . <br /> -\1 tVo cQv:E.(3.� . Buadti e?r..-.c9vct3srE--_R4AD13>??...�...: �.tl.I-R...y.../ ASH 1..N.. � <br /> i ------ ---------------­-------- ----- . .--- ----- ----- <br /> ? '}(Draw existing and required addition on reverse side),, <br /> I hereby certify I have prepared9his application and that the work will be doe in accordance with San Joaquin <br /> County OrdinaneIs, State Laws, ct rd Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: • t; <br /> "1 certify that in the performance of the work for which this permit is issued, I shall;ot_employ any person in such manner <br /> al 1A . <br /> as to become subject to Workman's Compensation laws of California." V <br /> Signed -r.-......Q 060......------------- Owner � D <br /> T R 0......- Jitle - i. �^.._.- <br /> By.-.....".. - - ........... ............................- t - .........----- - <br /> (If other Than owner) If <br /> ,1 1FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED-BY .-- - � - =Q` -------- - ----- . ....._.::::----:__ - -.............DATE � Q..-�1. ........ <br /> BUILDING PERMIT ISSUED ----- -` ----- --- ------ ---------- ----- ---------- ------.DATE. ----------...........---- <br /> ADDITIONAL COMMENTS --- - -- ------ � -- - - - ---------....------------------ ------- ....... <br /> .....-----"- .... - /-:-- ------------- -... //. <br /> - -------------------------- <br /> �..... t ' - - - - <br /> - - - -/----t----- ----- --------- ------ - <br /> Final Ins ec�7on- ---- ...... - - - -------------- - ----.Date ..-/,..:..:-- ..'- -- -------- <br /> J. <br /> P - •� � , - <br /> ------ . . - -- _., z / <br /> SAN JOAQUIN LOCAL HEALTH DISTRMT <br /> E.H. 9 1•'68 Rev. 5M , <br />