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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> .. <br /> ........................_..... ...------ -- <br /> (Complete in Triplicate) Permit No. <br /> --_-------•••-•------- This Permit Expires t Year From Date Issued <br /> Date Issued .. ...:..'f-.4-: y <br /> Application is hereby made to the So oaquin Local Health District for a permit to construct and install the work herein 4 i <br /> described. This application is madenn omplionce with <br /> �County Ordinance N/o.. 549 and existing Rules and Regulations: - <br /> JOB ADDRESS/LOC(���)pN+R_'..Y�.-/ 77--.-_ ---LN�---r .e// -� CC -- _-____-_---CENSUS TRACT ......._.._..._._ — <br /> Owner's Name 'G71�Y1..-- Phone <br /> __ S <br /> I B _ /� ._ _. . ___..— <br /> Address -------.-.... �. 7.:----G------r - ---+ ----... -- �.�Q-. City ---•---L.C. -•re-.�:er- - ... <br /> /j'_ Lia.ru.tr 183 <br /> Contractor's Name --__-� -- - �----- Phone ». <br /> ' installation will serve: Residence�ent House❑ Commercial flTroilerCourt <br /> 1 ( Motel F1 Other...............................•----- <br /> Number of living units:...--.- .... Number of bedrooms ... _ _Garbage <br /> a Grinder ..-_------- Lot Sim ....... 1.e4-n^ �5.__•• , <br /> r <br /> Water Supply: Public System and name _--.---__----_.-_ -.__---—.__.__......r.._..---------_...___-_».._.Prtvals <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑. Sandy Loam 0 Clay Loam j] <br /> fHardpan)] Adobe❑ Fill Material -.--------'-if yes,typo- ......... <br /> I (Plot plan, showing size of lot, I cation 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,J <br /> PACKAGE TREATMENT [ ] SEPTIC TANK t ] Size..... :.:- : --- ---- - - liquid Depth ......--..__.. ..,__.. NZ <br /> Capacity ....-............--- Type —.......... Material..__..--.......----... No. Compartments .-..._...._.._..... <br /> Distance ItIo nearest: Well ..................................:.foundation .----z................ Prop. Line <br /> LEACHING LINE [ ] No. of Lidos .- ............... Length of each line------- ------ Total Length ------------ -_•• <br /> 'D' Box J-... -- Type Filter Material __Depth Filter Material _—.._—_—.__----_- »•.-- <br /> Distance to nearest: Well -----------_----------- Foundation --- Property Line <br /> SEEPAGE PIT [ ] Depth ---4.... .....-.... Diameter Number .......-..........._..._--- Rock Filled Yes J] No Q <br /> r <br /> Water Table Depth ............. ......_........»..»_:--._....Rock Size --...._....._................. <br /> Distance to nearest: Well _._.� ._.--•.» _.-- -_-__•Foundation ... ....._ ?__ Prop. Une ......•--_•----------I Date <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------ ------- <br /> Septic Tank JSpecify Requirements) .-_............._..- - ^.--_-.........._.._....-•--......-.^ — ..-_......... <br /> i Disposal Field (Specify Requirements) ---------il—vpe-fir•• • <br /> i •----"----- I IDraw existing and required addition on reverse side) <br /> 1 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 Son Joaquin,Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: - <br /> .4 <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 California." <br /> Signed--------.-- ---------- `.-. -_ . - ------ Owner <br /> ------.----------l- _ -----.. itle /��- <br /> �-- - ..._ <br /> (If other than owned (' <br /> "It DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- ------ - ............ ............._._—__._.___.._».__ DATE. -L ....:� ...--.. <br /> ------------_-••----------••-------------•--•- _.._.-----------_... <br /> --......—._........DATE...................................... <br /> BUILDING PERMIT ISSUED...... <br /> ADDITIONAL COMMENTS.____.�___—.--- —_._--•---•-----------•-----• - -- — - ___.._._._.__.. —_....___._- <br /> ..__-__ <br /> ------------ - -- • -........... ---- -- -- --- ----- — - -_.. _--------------------- •—— �...... <br /> __- <br /> . <br /> ............. <br /> Finol Inspection <br /> by, ...-. _ Dots -."I-..- - - --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />