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f- _ 7�____.__E USE:,- APPLICATION—FOX. SANITATION PERMIT <br /> F 7 <br /> -------- -- <br /> Permit No.� _-_7 <br /> .. � (Complete in Triplicate) <br /> ---------- ---------A -------7---------- This Permit Expires 1 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 q existing Rules and Regulations: <br /> o Lp_i QO� V Elj f'9 VIO1-L4,eS UN-kr * Z <br /> i JOB ADDRESS/LOCATION L-6T. 777Ifi--------� I -------------------------------------CENSUS TRACT --------------------- <br /> Owner's <br /> ------------- - .-.. , <br /> Owner's flame - 1G 91�D - - a' �-C T------.- <br /> -Phone.-_.-_ <br /> Address ---- ) LNCDAQ-------;:�;T------------------ --•--• City -K�MC- y}------------------------------------------------- <br /> Contractor's Name ---------- ---------`-----------------------------------------------------------------License # ------ ----------- ------ Phone <br /> Installation will serve: Residence E/Apartment House❑ Commercial ❑Trailer Court i0 <br /> _. Motel ❑Other ----._____________________________________ <br /> Number of living units; ----- -- --- Number _ <br /> of bedrooms -3___.__Garbage GrindeerrPN_N_ Lot Size ----------------------- ------------- <br /> Water Supply: Public System and name _-_ j�-3_P-______hs9-wP1-;_' _--L. ---------` ---------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.0 <br /> Hardpan ❑ Adobe.0 Fill Material ------------ If yes, type ----------__________________ <br /> (Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION- (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [d SEPTIC TANK I ] Size_____________'____ '--------- Liquid Depth------------------------ <br /> I Capacity X4-80-- TYpsY Material-CC -- No. Compartments .=-c ________•:..-- <br /> t r <br /> Distance to nearest: Well ----------W�A------------------Foundation -----.f0----------- Prop. Line ___ ........ <br /> LEACHING LINE No. of Lines -__ Length of each -------t Total Length ---------------- <br /> 'D' <br /> --..__;___-_-__'D' Box --- Type Filter Material --------------------Depth Filter Material -------------------------------.------.------ <br /> Distance to nearest: Well __.- --------- Foundation ------I_u ---------"'- Property Line ________________________ <br /> I SEEPAGE PIT [ ] Depth '---------------- Diameter ---------------- Number --------------------_--_ Rock Filled Yes ❑ Nob <br /> c _ <br /> Water- Table. --------------------Rock- . :. <br /> Size -------------------------------- <br /> Distance <br /> -----------------------------Distance to nearest: Well ---------------------------------------- -------------------- Prop. Line ---------------------- <br /> RJEPAIR/A'DDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ---------_----------------_-_.----j <br /> 'Septic Tank (Specify Requirements) -- ___ ------------------------------------------------------------------------- <br /> SDisposal Field (Specify 'Requirements)`-•-------- -----=------------------------------------ ---------------=------ ---------------------------------------------- <br /> -------------------------7----------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------,--------------------------------..._..--------- <br /> ------------------------------------------ -------------------------------------------------------------- ---------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse.side]� <br /> 1 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 following: <br /> "I certify th 'n the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to b m ubje to man`s Componsation laws of California." d t <br /> Signe '" - <br /> �...� , -� ..._.,.....«._. <br /> _ Owne <br /> s1'rrc* L `V <br /> By ------ ---------- - <br />' � � - Titl .�f��_ <br /> -(If other than(owner]`, - ` <br /> �t J I FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> CC PTSD BY -------- 4 - ------------------------------------- ------------- DATE --.....f� -------------- <br /> BUILDING <br /> .-----------------------------------------------------------------------------------------=------------ DATE - ------------------------------- --------- <br /> ADDITIONALCOMMENTS - ------------------------------------------------------•---- ------------------------------------------------- ------- ------------------ <br /> ` ----------------------- ------------------------------------------------------------------------------------- ------------------- ------------------------------------------------------------------------ <br /> --------- --- <br /> ------------------ ----------------- ---------------------------------------------------------------------- ------------------------------ ---------------------------------------------------- <br /> ----------- - ------------ ------------------------ - ---- --- -- -------------------------------------------------------__-----------------Z----- --------------i-----=------- <br /> - Date ----- ` � --- ---------------- <br /> / --------------- <br /> Final Inspection by- ------------=- - --------- C <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. e �� <br />