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` FOI^OFFICE USE: .� <br /> APPLICATION FOR SANITATION PERMIT I ,�p <br /> ( omp ete in Triplicate) <br /> Permit No. -- ---------------- <br /> (Complete <br /> �`7/ <br /> This Permit Expire's ! Year From Date Issued Date Issued ----------------------------------- <br /> } <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/LOCATION ---Lane----------------- -------- -----------------------CENSUS TRACT ----- -------------- <br /> Owner's Name -------------------FL1.A1.0 fttsmot*-------------------•---- ---Phone -3 <br /> Address9a 1ac3�'ield------------------------------------------- City ­10di-------------------------------------------------------- ------ <br /> Contractor's Name ---- OiJ I &-- ' ] C---'Tank—_ #qtr-----------------------License # 251j-27-7------ Phone -53,7,440P- <br /> Installation will serve: Residence It Apartment House-❑ Commercial ❑Trailer Court f] <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:---------- Number of bedrooms 3--t-- <br /> -----Garbage Grinder __.-__--__-_ Lot Size -----'1),11-_--acres-- <br /> WaterSupply: Public System and name ------------------------------------------------------------------------- ------------------------------------Private PJB <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay-Loam ❑ <br /> Hardpan ❑ Adobe E] 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 /> � I <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ } SEPTIC TANK'[ ] Size- i-OX5-5-------------------------- Liquid Depth ---1-2.00--ggl, <br /> Capacity --120i3-------- Type+Pre-cavt---- Material--Q0LCre-tjD No. Compartments ---2-------------- - <br /> - <br /> Distance to nearest: Well -appjro$.__- 54-------Foundation -----_®1----------- Prop. Line -&pprADX• -5011 <br /> LEACHING LINE No, of Lines __ Length of each line--__ Total Len t - <br /> 'D' Boxyeg----- Type Filter Material S.G -j-G---r-&fth Filter Material --I-Vt---------------------------------- <br /> Distance <br /> ------------------------ - -Distance to nearest: Well <br /> appr13x7-5f-- Foundation 1-01----------------- Property LinekPPr,=Y---1-0j:. <br /> SEEPAGE PIT Depth ------------------------------ <br /> [ 1 p -------------------- Diameter -------------_-- Number _ Rock Filled Yes ❑ No .i❑ ,. a <br /> Water Table Depth --------------------------Rock Size -----------.-------. ---.------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --_-_-_---_-___------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------_-------------- Date ----------------------------------) I <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------------- ----- ----------------------------- <br /> DisposalField (Specify Requirements) ------------ - --------------------------------------------------------------------------------------------------- <br /> I <br /> -------------------------------------------------------------------- <br /> --------------------------------------------- <br /> (Drow 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 Work-Mari's Compensation laws of California." t <br /> Sig --------GU&Ias--- T <br /> T2C' <br /> L- ©� Owner <br /> BY = - ------------------------------------- Title - -n&ger-- ------- ----------------------------------------- ' <br /> (If other t an owner <br /> FOR DEPARTMENT USE;,,QNLY <br /> APPLICATION ACCEPTED BY - <br /> - ---- ------------ ----------------------------------- <br /> ---------------------------------- DATE Al-I-A---71 <br /> BUILDINGPERMIT ISSUED ------------------------------------------------------- ---------------------------------DATE ------- ----------------------------- <br /> ADDITIONAL COMMENTS ------------ - --------------- <br /> ------------------------ -------------------.-------------------------------------------------------------------------------- ------- --------------•----------------- -- --------- <br /> - -------------------- --------------- <br /> ------------------------- --------------------------------------------------------------- - <br /> Final Inspection by: --------------------------------------------------- ---- Date /7/ .--.7 --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />