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// APPLICATION FOR SANITATION PERMIT <br /> :......_.,.._....... !•• f-r. _ �^........... ._(Complete in Triplicate). .. ..__. Permit No. _7r:7115 <br /> .» .;.. <br /> _.... ""'Thi'a Permit-Ex i _�.1._`.�..-.Z7- <br /> ....................•_........_.......---._.------• p t+es 1 Year From Dohlasued 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 rmade in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION �v.�,� 1�.L CENSUS TRACT <br /> ..... ;•-- .--- -- - <br /> Owner's Name . ............ ., <br /> :... �A� <br /> _ <br /> Address <br /> . .... .... . .. ... ... ... ... .. . <br /> Contractor's Name .....:. .......:........License# ;:2W-5 y -.Phone <br /> Installotion�will serve: �,",Residencep[Apartment House Commercial oTraller Court ❑ <br /> i <br /> Other ...'....--.........................� <br /> Number ofilivin f.�tlibe'r7bedrooms -_•_•..g units:...--- _._..Garbage Grinder,_..-•-_-•.�- Lot Size ._....�_r,�--:�,-L�' ..... <br /> Water Supply: Public System and name► } ' 4 v......:--_•--• -------- .............Private (� <br /> Character of soil to a depth.of 3 feet: Sand E] Silt❑ Clay [) Peat{] Sandy['Loam❑ Clay Loam <br /> ❑ <br /> r' Hardpan�] Adobe FILE Material <br /> ............ If yea,type ............... ............ <br /> (Plot plan, ['showing siie1'k!&IJt, location of system in•relatioh to wells, buildings, etc. must be plated on reverse side.) <br /> NEIN INSTALLATION: (No sop c tank or seepage pit permitted If-public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANKS ] Size..................: Liquid Depth <br /> .....-•-• .................•------ <br /> t Capacity' _ <br /> ...-+�---=--------- ....Type _-------:----__--.. Material._ __ No. Compartments <br /> D`tar1ce to nearest: Well ...---------------------------------Foundation s........ ..__•__.. Props Line ....___••-___:_-._... <br /> f ] D' Box •_..�.`.:" T e�Filter Material'i of each line....................�.Notal, Length .....:........ ............. <br /> LEACHING LINE No. of Lines _..._.._---- -_,.--•Len th <br /> yp ....................Depth Filter Material"- �..... }' <br /> Ristance tol,.ne6restr;Weil .............. ...... Foundation ...................:.... Property Line..... <br /> (� <br /> �%.... ......... <br /> SEEPAGE PIT [ l Depth ---:..--.'-....-__ ;iameter ...-------- . ..... Number ................. w . <br /> .......... Rock Fitted' Yes ❑� No 0 <br /> Water Table Depth ....................... =--....._........Rock-Size ....}•......................... <br /> i <br /> f � <br /> Distanceto nearest.. Well ..............................:..........Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit ------------------------------------------ <br /> Date ....i-----:..------._:_--._.......) <br /> Septic Tank (Specify "Requirements). -_:........................... ......... .•--•--:___-• <br /> i �y .. ..••--.. ...........R. <br /> Disposal Field (Specify Require`iri ts) .............c.(i�'L __ : Q-` ------ <br /> - <br /> ... <br /> ------------------•---•-••----------------- - ...... 6.��_ �..�.._ <br /> .......•-••---•--------•........:........................•---- <br /> I ---- ----- <br /> - <br /> g squireand <br /> (Draw existin r ) ( "......... :. <br /> d addition on reverse ...side ! � � <br /> I hereby certify that I have prepared this application an #hat the work will -be done in accordanta Mwlth San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health,District. No owner or licen- <br /> sed agents signature certifies the following: { i <br /> "I certify thpt in the performance of the work for which this permit is issued, ! shad not employ any parson in such manner <br /> as to become subject to Workman's Compensation laws of California.- <br /> Signed ........ <br /> alifornia." <br /> Signed �.. -- -------. Owner <br /> By . ..-........ - Title <br /> (I Cher n owner) _... '. ..... <br /> �DEPAR7MENT USE ONLY <br /> APPLICATION ACCEPTED BY ...4::-_ ..�------ -_ ._ DATE <br /> BUILDING PERMIT ISSUED ............ .... DATE <br /> ADDITIONAL COMMENTS .................. -4 Y�✓ <br /> ................................ r <br /> ----------------•:..........• <br /> .. .... . ..... ............ .. . . --•--•.._.....Date ---- <br /> Final Inspection by: -- �_r. �7.T............. <br /> EH 13 2L 1-68 Rev, 5M SAN JOAQUIN LOCAL HE LTH DISTRICT 8/7h 3M <br /> 4f, <br />