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FOR OFFICE USE: � � <br /> APPLICATION FOR SANITATION PERWT �� a <br /> --------------------------------------------------------- I - Permit No: - <br /> . {Complete in Triplicate} - ; <br /> ____________ __ __ __ ____________ ____________ -` This Permit Expires 1 Year From Date Issued Date Issued <br /> Ila _. <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made>in c6mpliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ._ _ i =___- `'� _ :��-----------'-----> sS '---------CENSIS"TRA�T �_,_____ <br /> Owner's Name ---T_ ��_ -N-C _- -_ET �. _ lT ---_.Phone i <br /> ! ------- <br /> 49"j -- -- <br /> Address - �Q QN_ ---- ----------------------•-----.------ <br /> - -- <br /> Contractor's Name -----E11A.!_���__ -- ------------ -------------------=-�------.License # -------'-----'---='--- Phone �--------------------------- <br /> Installation will serve: Residence Rpartmerit House❑ Commercial ❑Trailer Court 'C] <br /> Motel ❑Other ------------------------------------------��/ n <br /> Number of living. units:_.------- Number of bedrooms _Z-----— _Garbdge Gri dprA -L---- Lot Size ffj(A_E 4_4F_— _.___..... <br /> Water Supply: Public System and .name._ `-------------.------ ----------------------- ---------------------------------------:........... =---_.Private E]Character of soil to a depth of 3 feet Sand'❑ it <br /> ❑ Clay.❑' (PeVt E] Sandy,Loam • Clay Loam:❑ <br /> Hardpan ❑ Acfobe Fil WOeria' if y}es, v pe ---------------------- <br /> (Plot <br /> ___ -__ <br /> (Plot plan, showing size of lot, location of system Nin re_latioh to wells, buildings, etc. must be placed. on. reverse side.) <br /> NEW INSTALLATION:: (No septic tank or seepage pitipermitted`if�public sewer is available within 200 feet,) ! f <br /> PACKAGE TREA`fMENTs [ SEPTIC TANK'[ \.Size- �'` =-_ ------'---- --------- Liquid Depth -------------. -.--------- <br /> -------------------- <br /> -Capacity --- Type Materirsl- - - ""�o. Compartments _--- ---- - ------•-• <br /> ell budtifi 1_�Prop.�lie�s ` --------- <br /> Distance to nearest: W, -�'- -- _ <br /> LEACHING LINE [ ] No.jWines -------------------- - Lengtli,of each ------------------- -- <br /> j Total Length .___._____ <br /> ----------- <br /> # D' -----k:----- Type Filter Material --------------------Depth Filter, Material -------------------------------•L-----___--Distto nearest: Well ------------------------ Foundation -_-_____.__'�---_.____-- Property Line --------_-•-€--__-:-- ' <br /> SEEPAGE PIT Depth ------------- ------ Diameter ---------------- Number5� -1�li'ack Ilea�Yes ] ` 'No i❑ <br /> { <br /> Wates Table Depth ------------------------------------------------Adck5ize ---------------- -----•--------- <br /> D'istanee to nearest: Well ---------------------------- ---- -- Foundation -------------------- Prop. Line ----.--.________-_._-- <br /> :W C <br /> Septic Tank (S ecif� Re uirements) ---------N�$�---]3QX_______.__60_-'_= ' -- ---- } <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- <br /> Disposal Field (Sperfy. Requirements) - '----------- ------------------------------------- <br /> . r f <br /> r �y----- --�-- -------------------------------------------------------------- -------- <br /> ---- <br /> i 1 . <br /> TM_ -. - ,,,.. �._ _. T,.,_-q_Fe - ,-, <br /> �"',� , {Drawexistin and're uired addition on;rever-se sid`er" <br /> I hereby certify that ;I shave prepared this application and that-the work;011%e 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: i k <br /> "I certify tha the perFofrman of the work for which this permit is issued,.I shall not employ any person in such manner <br /> as to beco a subject to'sWork n's o pensation laws of California." <br /> -- ------ Owner' <br /> Sig' -------- '------- - ----- ---- - - '-------- --------------------- - - ,. <br /> r • <br /> BBy i .� i f� Title <br /> ---- --- ------- ------------- -:------- :------------------ --- <br /> (If other' than owner) # <br /> s FOR DEPARTMENT USE ONLY <br /> APPLICATION <br /> O CEDBY . --- ------------------- ------------------------------------------- --- ----- DATE ~ � ------- <br /> BUILDING <br /> ------ <br /> BUDINGERMTSSUD ----- - -'- -----DATE ------- <br /> : - ------- -- ---------- <br /> %7 COMMENTST_-_� !T � . — P-rcc------ <br /> # 4NKS _440404 --------- ---------- <br /> ----------SPT1 - -- <br />' ------------------------------------------ - - ------------------- - ------- --- ------------------------------------ <br /> .� ..� f, <br /> Final Inspection by: ---------------------- --- --- - - ----------- <br /> ---- ----------- <br /> Date ' <br /> SA DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br /> s <br />