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FPR OFFICE USE: <br /> ?�` v APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. _.7.3_-- <br /> p . � <br /> p - " 3. <br /> ------------------ <br /> Date Issued <br /> ----------------------------------------------- --------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein I <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> I <br /> JOB ADDRESS/LOCATION ./�6�­/--- 77- ------------CENSUS TRACT i <br /> -�-��'� - _fir_�- ----- - ----------------------- <br /> Owner's Name __�. TI'L ��lC� ��_; � - - Phone <br /> Address., - ---~ Cit /.V <br /> T Y�= CL <br /> Contractor's Name _ __ � -' <:i <br /> .� r '=-------------License #�7� Phone <br /> lnstalla"tswill serve: Residence ❑ Apo rtment,House-❑+Commercic&[]Trailer Court ',❑ <br /> - Motel(ROther _ Ye <br /> - - - --------------- <br /> Number of living~`units:_-___.._ Number of bedrooms �_`- ______Garbo a Grinder / <br /> �,. 9 �D Lot Size --`-- Z=f ----------------•- <br /> Water Supply. Public System and name --------------------------------------- j ` --------;--------- ------------ - --- - " " Private'' <br /> Character of soil to a depth of-3.feet: Sand'❑ Silt,❑ Clay [] Peat❑ Sandy Loam -F] Clay Loam;❑ <br /> .. <br /> Hardpan Adobe ❑ Fill Material _____.-------` � .., ; - if yes,type ------------------ ----=-='-` 1 <br /> s <br /> (Plot plan, showing size of lot, location of system in relation' to wells, buildings, etc. must be placed on reverse 'side.) t <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available"within200 feet,)'` <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [J Size-----------------------__ --_____"_--_ .Liquid Depth ----------------_--""_-. . ^� <br /> Capacity = Type ---------- i-- Material---------------------- No. Compartments ---------------------- <br /> Distance <br /> ----------=`Distance to nearest: Well -_--------- -----------------------Foundation ----------------"-_ -- Prop. Line ---------- ,--••-"-- <br /> LEACHING LINE " <br /> -- <br /> [ l Na. of Lines ---------------- L`e�ngth.of each line---------------------------- Total Length _----------- ---- <br /> 'D' Box•------------ Type Filter Material ______ -- --- - <br /> Depth Filter Material ------------------------------ <br /> Distance to nearest: Well ________ -------=-:_ Foundation --------- -------------- Property Line. - _ __ __ <br /> 1� f <br /> SEEPAGE PIT � �1~ <br /> [ ] Depth -------------------- Diameter ------=---r"- Number ---------------------------- Rock Filled Yes ❑ No 0 <br /> Water Table Depth - _______ _ _______Rock Size <br /> } <br /> Distance to nearest: Well --------- a,-------- Foundation -------------------- Prop. Line ----------_----------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------- --------"-"-- Date <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) -------------_lam(?"."�T----- <br /> ,� <br /> -------------------------------------------------------- . <br /> ----------I------------------------------------ - <br /> (Draw existing 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 /> fPounty 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: j <br /> certify that in the performance of the work for which this permit is issued, 'I shall not employ any person in such manner k <br /> ' -as to become subject to Workman's Compensation laws of California." - <br /> 5igned ---- ----------------- ------------------------ Owner <br /> By -------------------------------- --- -- -------- <br /> (If <br /> other t a owner) Title <br /> - - ---- ------------------------- <br /> R - <br /> } <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYC/_ -" <br /> DATE _7 --7/: ------------- <br /> BUILDING PERMIT ISSUED * ------------------------ ---------DATE ---------------------- == <br /> ADDITIONAL COMMENTS ------ --- ----Qk ---- �� <br /> ------------------------------------ -- <br /> - -- ----------------------------------------------- ------- - -- - --- -------------------------------------------------------------------------------------------------- -- <br /> ---- <br /> Final Inspection bY� <br /> _ -------- : -- --- -- ---- Date ------ -- -- ----- <br /> �� J UIN LOCAL HEALTH"DISTRICT <br /> E. H. 9 1-'68 R (5M` ' <br />