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FOR OFFW", <br /> APPLICATION FOIL SANITATION PERMIT <br /> -- Per No. .. -�.-ql�� <br /> (Complete in Triplicate) <br /> ....::.......,........._........_............. <br /> ._.' <br /> _,,,,,,,,,,,,, This Permit Expires 1 Year From Date Issued Date Issued •��- <br /> Application is hereby made to the San Toaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ...`�. ,.. ._...S'-4? CENSUS TRACT ..................... <br /> �. .—. 42--v <br /> n Phone ..'rtrra `-. . <br /> 2.956 <br /> Owner's Name .�_.,$..-•--- -- •- --- !fid ��'...-••------••---.....•-•---•---•-. --.... <br /> GT ! <br /> Address ---�.�-��--�--�..-----.��....�Q'��f-•�5-----------------------•--------••--. City _.•,�.�---- - <br /> -----------------------•-- ------.•..- <br /> Contractor's Name .. / - ,�.�'l� 7�' . '7C License#1.� _3.. Phoner -rr�.?� <br /> Installation will serve: Residence 21-Apartment House Commercial:❑Trailer Court ❑ <br /> Motel ❑Other..-•-•-•--• ................ -------------­- <br /> Number of living units:---/....... Number of bedrooms _A___..Garbage Grinder VV.. Lot Size ._ 5__a-__13Z •••---• <br /> Water Supply: Public System and name ....................... •--.----------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam {.n-- Clay Loam,f] <br /> Hardpan ❑ Adobe-0 Fill Material ............If yes,type..------- pay <br /> (Plot plan, showing size of lot, location of system In relation to wells, <br /> buildings, etc. must be placed on reverse side.) V <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> .i ' S�/. . Liquid Depth �'� -•--• <br /> PACKAGE TREATMENT [ ] SEPTIC TANK 1:�.— Size._ __ ... Li ui p •----•--•--• <br /> Capacity _� -ol> Type�!["� ? Material`� � <` No. Compartments ____________ <br /> Distance to nearest: Well .. X`Q........................Foundation ._111.__.__._----- Prop. Line _. �.._.__..__._ <br /> LEACHING LINE [4}— No. of lines ...9................ Length of each line---- � --- _..... Total Length —1.1 ............ <br /> _ /r <br /> 'D' Box 1! .. Type Filter,Material -�t�Gl�_.,Depth Filter Material ---f -••----••••--•--•--••............. <br /> Distance to nearest. Well -- 'U_____________ Foundation J0__..___--_-_.___ Property Line _�_------------•-- <br /> SEEPAGE PIT [ j Depth .................... Diameter ---------------- Number ----.-----------.----------- Rock Filled Yes ❑ No ❑ <br /> WaterTable Depth ......................_.........................Rock Size .........------------------•---- <br /> Distance to nearest: Well -.--....._.._...___..........._..-........Foundation .........._......... Prop. Line ----------_---•----- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........................................I... Date ---------_-----------------------I <br /> Septic Tank (Specify Requirements) -------_--------------------------------------------------------------------------__----------------......................----•.--..__-.-.--- <br /> Disposal Field (Specify Requirements) ......._--------------------------------------- ------•-------•---- ••------• <br /> _...•------------ ------------------------------------------------ ----------- .................................. -------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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 beco a s jec t Workman's Compensation laws of California." <br /> SigneI ................. . . .........--------- -----------•-------------. Owner <br /> ------ Title .......... ........................_- ------ ----------------- -------- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B .. _..... DATE ------1 .�'-- .. . ...........••- <br /> ----------------------------------- <br /> BUILDING PERMIT ISSUED---V--------- DATE - <br /> ADDITIONALCOMMENTS----------••---- . •---••-•----•--•--••----••---•-----•---•----•-----------•••-••---• ---------------•------ ----------------=--------------------------- <br /> .•--_out.._.... f.:._!l <br /> .....-•-•-•••---- <br /> N�rif l�-.`----_ ---x-10-'•-- --• ...... .. <br /> .-- •.._.. .--- -._ .. ••---••---- _...................... <br /> Ins ection b �/ %ww d ._ '' ./...�L_Q'.�r .� <br /> p ,y: ......:....... ''1...... _.. i 2 ._..��t1A...Y_.- ° t"_.. . .. `--� . •...-_._. <br /> vr_vSE' s L�e <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> WOO, c/ed ,-- l�odyyPrt -owner A.) S� ,c t/1 7 }rad 00/- t� <br /> E. H. 9 1-'6B Rev. 5M Qd dr 1(07V [ /r�!�' 'r f fou fh. /� I �"t64 /'1a d Dorf e <br /> ��r^r fs/44 <br /> 4 9vv� <br />