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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No <br /> (Complete lnjrlpllcato). <br /> This Permtt Expires 1 hear)`rem Dote Issued Date Issued <br />..................................... .......-•- p <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct.and Install the work' heroin; <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRfSS/LOCATIONZ s o ,G og rid• �T-._. w�?-t /. .Q.t.4!...CENSUS TRACT <br /> .. _.._ A. s ...._ <br /> Owner's Name ' C�_c�:£.5....- atuh/.....:........................................................_...;.Phone •-:•••-,.-•.,,........ <br /> ........:...:. <br /> W <br /> Address _ .-- 0Tl....... City !1.,..-••-•-••:.................I.--•--•..........---- <br /> Contractor's Name ..- s_- +�i° .I __.'�----• : .�-... I:i1__•._._...License Phone -1rd-p�7........ <br /> Installation will serve: Residence(g Apartment House 13 Commercial oTrailer Court 0 <br /> Motel ❑Other----••-•........:.....••--.................. <br /> Number of living units....-]...... Number of bedrooms ....I.......Garbage Grinder ............ Lot Size ..,69 ............. ...... <br /> Water Supply: Public System and name ................ <br /> ..................._. ..... ....................Private � <br /> Character of soil too depth of 3 feet: Sandt]. Silt❑ Cloy [-) Peat Q ' Sandy Loam ln' Clay Loam M <br /> Hardpan o . Adobe jA FIII Mater€al .....::.....1#yes,tripe <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed an reverse side.) <br /> NEW INSTALLATION: No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT I I SEPTIC TANK 0 size.... .................... Uquld Depth ...Z.-.- .....:...: <br /> Capacity 1 A O4_-_-._. Type Material_GnaarT-:9.. No. Compartments ..................... <br /> Distance to nearest: Well -NP_tiE.....-...:_ ......Foundation .1A _..._ Prop. Line <br /> i Length of each line..._. ... •• <br /> LEACHING ZINE � No. of Lines _._._;f..:........... g ..Q.`............ Total Length .._...1L�..-.�_....... . . <br /> ©. Box ..,�._._... Type Filter Material `E-..Depth Filter .Material .._..19.............................. <br /> i �. • t/ � <br /> 17istance to nearest: Well .�`��. ..-------- foundation _._. p:� ...�""""�Property dine ..... ........... D <br /> '` - �.--_-•_ Diameter �Z_`.... Number ..::................ <br /> ...... .. Rock Filled Yea No OV SEEPAGE PIT �Q Depth •- - _ �"~"-"' <br /> . Rock-Sizer....%�-`�:_ �_:....... _ <br /> Water Table Depth -. -------••.•••-----• , <br /> 4 Distance to nearest: Well -_-K -..._..Foundation----.:I::p....:._-. Prop: Line :...::::...... <br /> REPAIR/ADDITION(Prev. Sanitation)Permit# ...:. :. ..................•.:_._-:_-.- Dote ...-:___,....__.. '__.._.......I ,e , <br /> Septic Tank (Specify Requirements). <br /> ---••---..__.....•- ,-...••••--- ----•--••-••................_......_...:--:•-••. f......-.. - <br /> Disposal Field (Specify Requirements ............. <br /> F <br /> .-_--•--------------------•--------------___---------.........-,,..•----••------•--- ........................ ................... <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 wltb San Joa luln <br /> County Ordinances, State Laws, and Rules and Regulitions of the San-.JQaquin Local Health-0110rict. Herne owner or licen- <br /> sed agents signature certifies the following: <br /> ".I certify that in the performance of the work far which this'jermit Is issued, l shalt not employ any person in such manner <br /> as to become suj�te to Workman" Compensation laws of California." <br /> Signec._1`14.... #?, 5 _` .. ?7[.S- .......... <br /> .#-- <br /> By _.._------------ --•-------._.._..------ ............. --A?�L_A ------- Title ...........-.............. <br /> lif other than owner) ` <br /> FOIL DI=PARTMENT USE ONLY . <br /> APPLICATION ACCEPTED BY _._. -_- .................... •-.••_:._..--= __.._ DATE :.:,..3, —_'� =-------- --- <br /> ---------- <br /> BUILDING PERMIT ISSUED --------------- ......... -----------------------------------• -- -------...---.. -------------- -..__..-.,.. --•-_.._........... ........ <br /> ADDITIONAL COMMENTS --------------------------------- -....-,-_---------= == �.__... --._..._.......:.._..__.._....---.........- <br /> - Z. - :: : , i , . , <br /> --- <br /> ---- -------------• ....._.._..._... -- •............ _ -.-__. <br /> .....•---------. .......--•-•-........................... <br /> _-- <br /> ... ..� ---- Date -� -------•--•-•.----__.. -. <br /> _...... <br /> --- ----- -- <br /> Final Inspection by: ..................... ......-----------------•---...-•------,,._._ .._--V' <br /> EH 13 2!t 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7$ 3M <br />