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FOk OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> t Permit No. <br /> ..,--- .._..R_...-. .e. -.-- <br /> (Complete in Triplicate) <br /> ##, 3_.-.�:��� <br /> Date Issued ..... .•. <br /> This Permit Expires 1 Year From Date issued <br /> ...._..---•.. . <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/LOCATION • o .", ,''iff. nna11��.}}�-a�tt - .!_..��-4,*`•�--. • "-'----• CENSUS TRACT .....................::... <br /> [ Owner's Name .. .. �_.. . ...._d�! t._.- ..- _ .. ._.. •• _ <br /> Address . ✓�, w. -Calea-._.��-±� ....... ��.;y City y4 ........ <br /> " V <br /> " ' liEense # � -PM3 <br /> ----------­--- ., <br /> Contractor's Name ...._ .... <br /> - o�Sy- Sia <br /> Installation will serve: 7 Residence ❑ Apartment House Commercial-[]Trailer Court E] <br /> Motel []Other <br /> ,; <br /> Number of living units:.. ...,.. .. Number of bedrooms ------------Go bage Grinder ... Lot Size` 6S �0 <br /> Water Supply: Public System and name ..-•.................... .. i.-•-.... <br /> ..... -Pi ivate_ <br /> j----- --..._ . <br /> i Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material .._-........ If yes, type --•------------------------- <br /> (Plot <br /> ---- -(Plot plan, showing size of lot, location of system in relation1to wells, buildings, etc., must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewerlis available within 200 feet,) <br /> I ` � - '----'---- -•.- T` <br /> ,, <br /> Size _,�_ ---Xd- .... Liquid Depth _fi. .... <br /> .... <br /> PACKAGE TREATMENT SEPTIC TANK ...•._.. <br /> Capacity�O S�.r�-- Type -2./_- T. -••-I--- Material.- ..-.. No. Compartments f <br /> _:......--- <br /> r <br /> Distance to nearest: Well .-. 0D...1-'>�..............Foundation.....�0•-�.----. Prop. Line ---6 ....•------ <br /> t� <br /> LEACHING LINE No. of Lines 45, Length ,of each line. .-./b'4 ..-. Total Length .- ................ <br /> 'D'' Box Type T ilter M6teralE gQr-a)- ------Depth filter Material _._....f�..............� .--....lM <br /> t � �. <br /> Distance to nearest: Well ------------- Foundation ... ...Q..-t.....-_- Property Line ...�,__-._....__.....___ <br /> w �r <br /> SEEPAGE PIT A Depth __.__.-- Diameter 3`..._._.. Number . .. 4; Rock Filled Yes ``.No <br /> IWafter Table Depth -- -------------- --y__�•....___.__.__ --RoWSize ..- <br /> i G i ' I p�-� <br /> Distance to nearest: Well ..---� -0-�--------------------Foundation 4.1.---;-.-.....- Prop. Line .__........._._......:G� <br /> REPAIR/ADDITION,I,Prev. Sanitation Permit# --�---.-------. "--------'........... .. Date ---- -•--_-. -................ <br /> ) <br /> I . - .- -----•'---.....� -----`-° ............. ...--...---•--......-�.,...... ` <br /> I Septic Tank ISpecify Requirements! ,,, .- y� <br /> *mss .. <br /> Disposal Field {Specify Requirements) ._.... ' -- -•-•------ " tc -...-.-....: i"-._._... <br /> . '"tet1 i <br /> i ....... '--- - . ........ ..... ' <br /> .... ............ .......... .. f------------------------- --------- <br /> . , - <br /> {Draw existin and required addition on reverse side),. <br /> I hereby_certify_that_h have prepared this application and that the work will be done in accordance with San Joaquin <br /> I County Ordinances, State laws, and Rules and Reg lations of the San Joaquin Local ea tV biitritt, Home owner or licen- <br /> sed agents signature certifies the following: �` l <br /> "I certify that in the performance of the work for•-w,Ftich' this p rmiris issued, I shuMnot,employ any person in such manner <br /> as to become subject ' Workman_s-C-olnpensation laws of California."'/ -- <br /> Signed .... .... . ........ " -• �....--- ----- Owner <br /> ted,l ttT ).ut,By <br /> Title . .... ',�. . <br /> of ftot r an owner! <br /> �.. �+► f D TMENT,,USE ONLY <br /> APPLICATION ACCEPTED BY .... .. 1 ....... DATE ...3-� -77 ....... <br /> BUILDING,PERMIT ISSUED._.._. DATE . . _ _..---- /..._.- .. <br /> -...... <br /> ADDITIONAL COMMENTS' ---•----- c <br /> ..... ...._ <br /> • - <br /> ... --'--------- ------ <br /> " 2 _-_.... <br /> � _ / ` <br /> Final Inspection by: ., �'t` ---- ate .... ..<r� ...._... <br /> SAN JOAQWN LOCAL HEALTH DISTRICT <br /> a <br /> M` <br /> c v 13 24 ,_ sa eo., ,AA'i 7/72 3 <br />