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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ................. Permit No. TS "-?(/I <br /> {Complete in Triplicate) . <br /> _.. This Permit Expires 1 Year From Date Issued Dane Issue <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. 349 and existing Rules and Regulations- <br /> _1..q <br /> r . <br /> � Regulations: <br /> _ ..---• NSUS TRACT ..................... <br /> .....JOB ADDRESS/LOCATION ........ /G !... <br /> nn____ <br /> Owner's Name l �' ....... l�.•t?}5. /t?C.'...................................................Phone ........ -----.._ <br /> Address --- .......Ab.:__.44IN .....:...............•-----..-.city <br /> --, eaF33 <br /> Contractor's Name .....--- ......... --------------.._....._ <br /> Installation will serve: Residence�ipartment House] Commercial flTrailer Court I-] <br /> Motel❑Other............................................ <br /> Number of living units------------- Number of bedrooms � _...Garbage Grinder ._.......... Lot Size .................................. <br /> Water Supply: Public System and name ........................................................_........—....................................... <br /> ._.Privateer . <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay Peat❑ Sandy Loam 0 Clay Loam <br /> Hardpan❑ Adobe Fill Mctterlal ............ If yes,type............... ............ <br /> (Plot 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 [ ] SEPTIC TANK ] Size................... .. Liquid. Depth <br /> Capacity --- .............. Type -------------------- Material......_.......-........ No. Compartments ......................0 <br /> Distance to nearest: Well ....................................Foundation _..------ ............ Prop. Line ......................W <br /> LEACHING LINE [ ) No. of Lines ..................... Length of each line..-------_---•............ Total Length ............................ <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material .................--.-----______----.__..._._ <br /> Distance to nearest: Well Foundation Property Line ' <br /> SEEPAGE PIT ( ( Depth ------------ ---_ Diameter ................ Number _... ....................... Rock Filled Yes [3 No <br /> Water Table Depth .................... ...Rock Size <br /> Distance to nearest: Well ....................•...................Foundation .........._........ Prop. Line ------_--•----_-_- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ................................._-------- Date _-. ...............� <br /> Septic Tank (Specify Requirements) ...................:...---- .....-- • ..... . .----------••............-......................... <br /> ' J f <br /> Disposal Field (Specify Requirements) ------t, -- ___-_ 1.*J.------- •�--._Sc.". <br /> <. � ------� •.-------R.�- ------ ..............__ <br /> ------------- <br /> ••.. •----------------------------------- -------------- --------------- ------------ .............-.......... •-----------..--•--......._ ..................................................... <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 /> County Ordinances, State Laws, and Rules and Regulations of the Seer Joaquin Local Health:District. Home owner or licen. <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work far'which this permit is issued, I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------- -•- ' ... __ Owner o <br /> BY ------------------- -------­----- Title _.«�L�1 . ---- ��Y�-' �— <br /> other than owner} <br /> OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ - -- -. .. ---- �......•..---------- DATE .,SS.I -- <br /> Jl 71 ---•---- <br /> BUILDING PERMIT ISSUED ----------- -----•-----------------------•---•---•----------------_----DATE ........................... <br /> ADDITIONAL COMMENTS --------------- ----- <br /> ---------- ---------------------- _---- -----------•--- -----•-----....__.--••------.._..------------•---------------._._..---. -- / <br /> _.._._... --•......................•----------- .......---- ..----- '== fi <br /> Final Inspection b J --- ------- -- -------------------- <br /> P Y -- -------- -•- --- ------------------.-.---...-----.....--•--.-------------._Date ...... ----------------- <br /> EH <br /> 13 24 1-68 itev. l SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />