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FOR OFFICE USE APPLICATION FOR SANITATION PERMIT <br /> ---------------- - - ----------------------- C�-l_-:���! <br /> (Complete in Triplicate) Permit No: <br /> ----- This Permit Expires ] Year From Date Issued Date Issued � � <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/]�OCATfO/N^.__-.I _I_�- -__-,i _____Il ----- --P�7 I-------KID----------------------CENSUS TRACT _�-"--5-�.---- <br /> Owner's Name _ t�_.__CZ Qx P-- V-o-_j>_5I-_R_n--------------------------------------------------------Phone. gz3'53000_ <br /> Address --------- C-------(=---------------------------------- City ------l- // IV C '2--------------------- <br /> Contractor's Name --- C__-�n� 3 350—. { F� _"... . <br /> - ---- ----------------License - ----�---.----------.---- Phone _ <br /> a <br /> Installation will serve: Residence O'Apartment House❑ Commercial ❑Trailer Court kb4 l r <br /> Motel ❑Other- -------------- <br /> Garbo e Grinder -d_ <br /> �_ - Lot Size _._ Ri ____....._-. <br /> Number of living units.---I------- Number of bedrooms _ ------- g� -'�`A <br /> - i` Private <br /> IY <br /> Water Supply: Public System and name ________________________________ ___ �r <br /> Character of soil to a depth of 3 feet: Sand'❑- Silt❑ Clay ❑ Peau[] Sandy Loam Clay Loam ❑ <br /> _ A — �r _ _ <br /> Hardpan ❑ Ad be Fill Ma#erial /'V()-Ylf yes F <br /> l e ,_ ---- <br /> (Plot plan, showing size of lot, location of system/in relation to wells, buildings, etc. must be paced on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'I ] Size----------- 7—y-n------------------------ Liquid Depth -------------------------- 0 <br /> Capacity ------f/---------- TYI?e -------------------- Material,------------------- No. Compa ments -------- ........ <br /> r y1 <br /> Distance•to nearest: Well. 3-�---�------------------------Foundation ---------------------- Prop. Line ---..--.--............ <br /> ti 11 : <br /> LEACHING LINE �[ ] No. of Lines =----------------------L: Length of each line------`--------------.____-- Total Length -----------------•.......... <br />' I i f <br /> _------- Type Filter Materidl. j_6_:__t_..:. =_txDe th Filter Materiai <br /> 1,�trrFi' ay �F4Taim <br /> iilDistance ,to nearest: Well'___i_\_______________ Foundation -------------------------- Property Line -___-.__.-___.___..----- <br /> iSEEPAGE"PIT 6 ] ""iDepth., ________:_______ --------•Rock Filled Yes ❑ No .❑ <br /> _ biometer -- ----------- Number ---'--____-- <br /> i ! Water Table Depth ------------'-------___- - Rack Size --- ---------- --- - <br /> �. tt r <br /> 1✓ D.istance to nearest: Well _______________ _.___-_. oundation <br /> -------------------- Prop. Line ---------------------• <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- -- Date'__-___-_____-:-__--__--__--.____.) <br /> Septic Tank (Specify'Requirements) <br /> ) ` ` V, r� <br /> Esposal Field {Specify Requirements) IIY��T _L --------Dl �----10?C---------[QQ - Q Z --------W�--[� ----- <br /> 1-1_hl E::.-r - +CQMM_ lV- 1=VIl $OOL_-__ 4r1fC, 'Trc <br />.. ..�. - D -- rnlA_S-T - hF Q_ -'-I---wE�L -= QF,=Tir`,f1 - <br /> 4 ,(Draw exi ting 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..follor'ving: <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 Worm's Compensation laws of California." <br /> Sign / Owner <br /> gY]-r ------ <br /> ----- if' l�X /9 <br /> Title - - <br /> ------- <br /> t (If other thany w <br /> ^ y FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---- 'f �R-_�------------------------------------------------------------------------------ DATE ----F-=-��� ­�-------•-•---- <br /> BUILDING--PERMIT-ISSUED---_ ------------------------E - _w �-._. ... — _.�,: - —""--'DATE--------------------------------------- <br /> ADDITIONAL COMMENTS ----`j*"/ - --J�.l-/ f� --1 . k 1M_--i Jn AKj9........ F_f-Cti_/__nLC- PJ--�----------: <br /> = R4r�l-- =T O =ter =f= =X 6—`- — icrT� -- 3D <br /> . <br /> -----------------------��e <br /> ------------------- <br /> ------------------------------------------------------- <br /> Final Ins ect'P - -- --- =---- --- - - - --- --•------------------------------------ -Date -- -_E�___`_��---'..-- --- -�--- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />