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FOR OFFICE USE: %.. 62-k/ 92--767 <br /> APPLICATION FOR SANITATION PERIIAR <br /> .....'�..._.f!:....:�.....-'. ............::.. Permit Na <br /> (Complete in Triplicate) - <br /> �....-" <br /> ........................................,..... � _ <br /> This PartnitI*m 1 YeFrom Date Issued Dote feTsued .. -/f'...y <br /> ar <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 ADDRESS/LO ATI .LXl?.?`d .?.----f_W� .......... !! ..... . - CENSUS TRACT ......._....... <br /> Owner's Name EFS c(.(/t7.�.tJes lt...-..bf--�s�' 1G.-mer".... . -r.. ____-..-.-- a ....___...._-..._........__. <br /> Address .... -........ .... . . - - ... .---------.... city GL.........--.. . <br /> Contractor's - _License F A.. Phone ...............___.. <br /> Installation will serve: Reside 0 Apartment House-M Commercial oTrader Court [I <br /> Motel ❑Other-- ------ <br /> Number <br /> ---Number of living units:............ Number of bedrooms .....Garbage Grinder ...._...... Lot Size ....... ---•---- <br /> Water Supply: Public Syster}t and name __._.._ v J _-" •••--•---••-Prlrab <br /> _..- ....._-t..•._.... -'::- --».:_...............------- Xu <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam.❑ Clay loom 0 <br /> Hardpan❑ Adobe 0 Fill A46ter(al ............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 sewprµis available within 200 feet) I r, t, <br /> PACKAGE TREATMENT ( I SEPTICTANKe �? Size.J„ .A_-..-p......4.._.t .__ Liquid Depth <br /> Capacity . Typctr! /._ Matertal-• ?'�4.--•• Nq�CompartmeMs f_- .�__r,' <br /> / Distance to ne est: Well ....._.�...........................Foundation _.._..� ...:'.:: Prop. line ..._ _...:. .._. <br /> LEACI•ING LINE [II No. of Lines .......✓------------ Length of each line------ ------- Total Length .._s�R-A.-�—. <br /> 'D' Box _P'n� Type Filter Material ....§t!&t...__Depth Filter Material --------1,4..~_...__..........__.. <br /> r r <br /> Distance to nearest: Well ---1 tr4......_..... Foundation ['O.-_..... Property Line_ ..»._S._._---�._ <br /> r <br /> [Lj Depth ...1-�"-------- I �.X�.__ Number ..._. �// Rock Filled Yes ] No�1 <br /> Water Table Depth ..._...... R..�_... ......Acidic Size ...I.A __x_.f�.,--------- <br /> Distance to nearest: Well .»_._.1991..._._......_...Foundation ....6.(L.......... Prop. Line <br /> REPAIR/ADDITION(Prey. Sanitation PermitDate ........................ ----- <br /> SepticTank (Specify Requirements) ..............._-...___...---.:.:..........-........_......._...-._._...._ .._..-._.._..__..._..__._ .__........._ <br /> Disposal Field (Spoaify Requirements) .... ._.................. _.._...__-..........................................-----•---------------- .- <br /> - <br /> --------------------------------------------_....-----------_- - .......................-.... <br /> --- - - ---- - - - - <br /> _ ... .............................. - ...__......................................._.........:--.:................____..........................-----------------•--- <br /> (Drawexisting and required addition-on reverse side) <br /> I hereby certify that 1 have prepared this application and the't 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 DisMd. 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 Compensation laws of Caf(fornio.” <br /> Signed ..................................... --- -.J/ . .. Owner <br /> By --..-i.----•--.------------------._....------_-_�`�l C/-.._ � t7ltle .. 4� dE -............... . <br /> ..- <br /> I (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- -- - - -- ---- -- --• - - ---............................................._._ DATE J�:f ..'Z. --.. <br /> BUILDINGPERMIT ISSUED .::...................••--------..._-__.....__.-._._--•---•---•-----_.---...- -.-__._...OATE........._...___.__._._----_--__. <br /> ADDITIONALCOMMENTS .-,......_-'--....................................-----•--...-....-•-—.......................•............................. ; <br /> ..........-...--.......'.................. - _............................... .. <br /> �- ------------------------------------------i........-- --- -- ------------------------------------------.........................--..........................................._............ <br /> - ...... <br /> - ...._............ .. .... .........._..-... . <br /> ...._...:.-� <br /> _-` ... <br /> '-........ <br /> ........ ....Heol Insp.a(an <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT per <br /> E.H.9, 1=68 Rev. 5M C <br />