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FOR OFFICE USE: <br /> APPLICATION'FOR SANITATIQN PERMIT <br /> (Complete in Triplicate) Permit No. <br /> f <br /> --------------------------------------------------------- This permit Expires I Year From Date Issued Date Issued ._��:_ - 7L <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_ o. 549 and existing Rules and Regulations: <br /> JOB ADDRESSAOCATION ___7`_6-0--- <br /> - t CENSUS TRAA,�CC --------Owner's Name ------- - - _ - � --- --�3�--- <br /> -- ----- one -------------- <br /> Address ----------- -�_ � l `v'� <br /> ---- =-----•--- City <br /> --------------------- ---------------------------------- <br /> -- ------------- <br /> Name __________________F.4 ____ _ _ __ <br /> - - - ----V---- --------License # - /� Phone -- - - --- <br /> �„,{ ---- - ------ fit°-�'�0-7___ <br /> installation will serve: Residence Ili Apartment House�❑ Commercial "❑Trailer Court ,❑ <br /> Motel El Other -------------------------- <br /> Number <br /> ---- -------- -----------Number of living units:.._.. -..__ Number of bedrooms ----3.___Garbage Grinder ------ ----- Lot Size .___-.___ �+-� <br /> PP Y Y I - ---------Private ' <br /> Wafer'Su 1 Publics stem and name <br /> Char' ter of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ( <br /> Hardpan,E]` AdobeFill Material..__- If es <br /> F.__--_ Y type <br /> (Plot plan, showing size of lot;°=loco#ion of system''i'�relation to wells, buildings, .etc. must be placed oi��reverse side.) <br /> NEW INSTALLATION: = r , . <br /> (No septic-tank-or seepage pit permitted if publicsewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] TAN - Liquid .Depth SEPTIC C f <br /> t L .Dept --- ---------- <br /> Capacity <br /> - <br /> _ _. . Liqu - 0 <br /> = L. . 5 . i <br /> Capacity "„"' =: Type - _e Material --------------- No.' Compartments ------ <br /> -Distance-to--nearest: -Wel! __._.___. _I <br /> - ----------------------Foundation ----------- -- --- Prop. Line ------------- ------- <br /> LEACHING LINE [ ] No. of Lines _----- ---------------- Length of each line.._-..:____..__....__"_____ Total Length <br /> i i 1 <br /> k 'D' Box ------------ Type Filter Material --------------------Depth Filter Material <br /> 1 Distance to nearest: D almeter F `Foundation <br /> ------------------------ <br /> - -- Property Line <br /> SEEPAGE PIT.., [ ] Depth = <br /> "' --------- ---. Rock Filled Yes ❑ No C] <br /> Number <br /> ------- --------- <br /> Water Table Depth ------------------- <br /> ----------- <br /> --- Size <br /> Distance to,nearest. Well __________ ___I'____------_--_-_ Foundation -..._._______ <br /> . ------- Prop. Line _-_------------ <br /> ` - <br /> REPAIRADDITION(Prev. Sanitation Permit# _....-__..._--.____. __ <br /> -------- Date <br /> tSeptic Tank (Specify Requirements) ------------------------------- __ EJ <br /> Disposal Field (Specify Requirements) ._._.._-_ . � _�� <br /> _T <br /> ----- .� _.... <br /> ==- _ ----------- <br /> t (Draw existing and required ad_dition on reverse side) <br /> I- herebycertthat I have prepared this application and that the iwork will be done in accordance with San Joaquin <br /> County''O�din nces, State Laws, and Rules and Regulations of_the. Shin Joaquin Local Health District. Home owner or iicen- <br /> s-ed agents signature certifies the following: <br /> "I certifythat in the <br /> performance of for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensdtibn laws of California." ,.. ' <br /> S s rr wµ - .• <br /> Signed ------ l <br /> ------------- ---------- <br /> - - ----------------------------• Owner <br /> BY - --- - ----- I <br /> L - - - ------ Sitle -------- ' <br /> {If other tha caner) i ----------------------------------- - <br /> F ! <br /> i FOR DEPARTMENT USE ONLY <br /> AP PLICATION�ACCEPTI°D BY _._____ - <br /> ... <br /> - ------ ----- -- ------. DATE ---�t'�"-- •-•--- � <br /> BUILDING PERMIT ISSUED ._-..__..-.___.i -" -- <br /> - ----- --------------- <br /> ADDITIONAL COMMEN �_ i - u <br /> ----*�- -------r-- - -- -- - - ------ <br /> ._� _ 1--- - --f-- ._...-A------------------- - <br /> 9 f/. <br /> -- oe -v �` ;;------ '-— --------v---- -•----�-- --- ---7�9 y._ <br /> G' <br /> --------------------------------- ----------- <br /> - -- ------- - <br /> rah s � --- --------- -------- -------- --- ------ ---- <br /> Inspection b - - ----------------------------------------- ----------- --------------------------------------- <br /> Final �--------- <br /> p y- ------- --- <br /> - - - - - ------- --------------------------------------------- --------------------- -------,Date ----- --= <br /> JO UIN LOCAL HEALTH DISTRICT �f <br /> E. H. 9 1-'68 Rev. 5M ,� <br />