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*' F6R OFFICE USE: <br /> APPLICATION F& SANITATION PERMIT <br /> ................................ }(Compl •e inTriplicate} Permit No. �1 <br /> ............... ................................... <br /> q - ._.... <br /> This Permit Expire i 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/LOCATION ............4.A �if�._ ..... .._. .........................._..............CENSUS TRACT ..............:........... I <br /> Owner's Name ............. .► ...x + _tatt��iv............. '. ........PFtone ........._.. :. <br /> .... i <br /> Address ............ ----------- '7_ rEr._ ...... ------- ................ City ........... ............... ...:. <br /> ............... <br /> Contractor's Nome .............................................. I <br /> ti <br /> ------•............:.......•-------------...Licensee# -----•_...-:.._..------- Phone <br /> Installation will serve: Residence (:]Apartment House Commercial OTroller Court 0 <br /> Motel j]-Other Y�I ly 14 <br /> Number of living units:..... Number of bedrooms; ..-__.Garbage Grinder _. ------ Lot Size .......1. ..V .= c .......... <br /> Water Supply: Public System and name _ _ _.-.Private J9 <br /> Character of soil to a depth of 3 feet: Sand o Silt�0 _ ClayV 0 ' Peat❑ Sandy Loam 0 Clay Loam <br /> F Hardpang Adobe'Q Fill Material ............ If yes type ..............I------------- <br /> (Piot plan, showing size of, lot, location of'.system-in.relation--to.welts;-buildings, etc. must be placed.. on reverse side.) <br /> NEW INSTALLATION: <br /> (No septic tank or seepage pit permitted-if public'sewer is available within 200,feet,J i <br /> PACKAGE TREATMENT t � j ° � ---- Liquid Depth .............. r � <br /> [ l�: SEPTIC TANK Size....................................... . ..........._ `1 , <br /> r ti a <br /> pacify .14-.'Type(If, Material C <br /> '. . No. Compartments <br /> -- <br /> Di ance to nearest- ..P:.........Foundatibn - Ao.......•'-"• Prop. Line .......tp.f 1 <br /> /' <br /> LEACHING LINENo:. of Lines X--_. --- Length of each line---..:7_a-__' ----------. Total Length. <br /> 'D') Box ... Type <br /> 6J <br /> Filter Material ____Depth Filter Material . ...............-. <br /> Distance to nearest: Well ....... .- ..... Foundation :..�Q.. ........... Property Line-... <br /> Vt <br /> SEEPAGE PIT- [ ) Depth --------- .......... Diameter ............... Number ----------------- ......... Rack Filled Ye� No <br /> Water Table Depth ............... -----•---.------ Rock Size _.... (' <br /> .. �+ <br /> Distance to nearest: Well .............' -r .................Foundation ............. ..._ Prop. Line --_----..._ ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit* ............................................ Date .................... ......:...... <br /> ) <br /> Septic Tank (Specify Requirements) .............................. - Y- ........................- <br /> DisposalField (Specify Requirements) .--•---------•----------_-------------------------_---- ----------------------------------------------- ............... <br /> ....................... ------------.._.....__.......I-------- ....... ' ... .,........................ ------....'....................................................... . - <br /> (Draw existing and required addition on reverse side) <br /> t � <br /> I hereby certify that l have prepared this application and that the work will be done in: ccordanca with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations f the Sari Joaquin Local Health"District. Horne owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such mariner ' <br /> as to become subject to Werkman's Compensation laws of California." <br /> Signed ........................... r-•--•-•---------...----------------• - ----•_....---. •'" <br /> _ Owner <br /> By .................................................... --- .... ..--- -- ------ .Title ........................ _. _ . <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE ..... `..... .......... ...... <br /> BUILDING PERMIT ISSUED ..' --- --------- ---......... ...............................................................DATE ----------........._. ..................... <br /> ADDITIONAL COMMENTS .._:..... . ---------------------------------- ....._ <br /> _...._..._.......... _ <br /> ....--••-•-- <br /> Final Inspection`by:-..------ . ` -- . ............................_... ...............`-... r....._. ......... <br /> _ f' Date .. .. s: �. .�/........... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> c u 33 24 , •moo n_.. cu. - -' ^�,.�-.� - ... 7 1 77 Z ►r <br />