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FOR OFFICE USE: ¢ II <br /> ........... APPLICATION.FdR SANITATION PERMIT <br /> I <br /> ......,.�.,..,�_. ....�•,,..,...�_. .�.. .,_.�.., ._._.., �`j ` Permit No. _� ---7W <br /> --- i'Complete in,Triplicate} <br /> ---____-___-_ ! t__ �.� This Permit Expires 1 Year From Date Issued Date l�ssued ___�- 7--'-. <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 FADDRESS/LOCAT N ------ <br /> --CENSUS TRACT -------------- ` <br /> Owner's Name -� __ ---Pho � <br /> --- -- --------- ------Cit--- --`� �- <br /> ne <br /> Address .------ - Y M --------------; <br /> ---------------- <br /> t t -------- <br /> Contractor's Name ._._ -______ License # Phone <br /> tl <br /> Installation will serve: {Residence,k.Apartment House-C] Commercial❑Trailer Court ❑ <br /> k 5 _ <br /> Motel ❑Other ---------�*\ <br /> _. <br /> Number of k'iving uni'ts:_=_= ,Number of bedrooms _ ------Gar6a / <br /> Garbage.Grinder _.______._._ Lot Size ___ `` - _ -- <br /> 9 �----,M _ <br /> , - <br /> Water Supply: Public System and name--------------- -------- �- �__f�rivate X. <br /> --------------- - ------------------------------------------------------------Character of soil to a de th of 3 feet:-5—dnd� Silt,. ~y Clay 1I <br /> „• p ► i� ❑ y ❑ Peat ❑ Sandy Loam Clay:Loam ❑ <br /> f Hardpan[] Adobe[j �FII1_Material" ---------_,If yes, type ------------------=��--:----- 1N <br /> 4 _ t <br /> (Plot-plan, showing size of lot° facation of:system in relation to wells, buildings(y etc. must be pfaced <br /> k or 'on reverse `side.) <br /> : {No septic tan <br /> NEW INSTALLATION '`seepcige pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ 1 SEPTIC TANK k[ l Size---- --------------- :------------- <br /> ______---_ Liquid-Depth <br /> 1 ICapacitY TYPe Material------1--------------- No. Compartments -•------------------ <br /> Distance <br /> -------- ------- <br /> I Distance to nearest: Well _________-_ i <br /> ------ Foundation ---------------------- Prop. Line <br /> - L•en - '� �� <br /> LEACHING LINE A(j No,of Lines-----___. __ �gth of' each line_-A��__�-_---- Total Length i�6d4 <br /> l'D,' Box'i ---- Type Filter Material -------0,-- -Depth Filter Material :---_- --T:---• <br /> ---------------- <br /> Distance <br /> -----;p---•-Distance to nearest: Well ____ .J { ,, e <br /> Foundation __ <br /> SEEPAGE PIT EDepth ____ �`--�_ Diameter Rock Filled <br /> ---------- <br /> 1 p(`f ;Y; r - d ' t-. Number _- PropertyLine <br /> No <br /> Water Table Depth --------------��- ----- 1 <br /> r:�. P ----------•-•--Rock'Size ------ - -----•------ <br /> 1 <br /> t :Distance to nearest: Well -----_ a _:__,__________'f__Foutidation -__- ��� <br /> .��� Prop. Line <br /> REPAIR/ADDITION(Prev`_ Sanitation Permit# ----------- -- ------------ Date F_______•--•--------_-__-- ---_--_-} <br /> Se-ptic Tank (Specify Rie uirements1 . <br /> i <br /> ---------------- <br /> Disposal [Field (Specify Requirements) ---------------mac7__-- <br /> ------------------------------------------------- �"�� �� t ' --- - <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 San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "Icertify that in the performance of the work for which this permit is issued, I shall not employ any person to such manner <br /> as to{become subject to Workman's Compensation laws of California." } <br /> ----------------- <br /> ----~ -� - — _ Owner —.Zr. <br /> B h <br /> Y = ------ Tif le iS-- < ; <br /> - <br /> � <br /> (If other than owner) •. <br /> --------------- <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--__:___ DATE _ — 11 <br /> ------------------------------------•-------------------- <br /> - <br /> BUILDING PERMIT ISSUED _________- _ ._ t - <br /> ---- - -------- -------------- ---------------------------------=----------- -DA <br /> ADDITIONAL COMMi S` TE <br /> - ---- ------ --------- --------- ------ ------- <br /> t ------------- --------------------=`--------•---------------- <br /> l� ` -- ----------------------- <br /> T i $' 'moi' �"Ph L/F II <br /> ----------- ----- - �- <br /> ---------- - <br /> ---------------- --- - -------------- ------- <br /> ------------ ------- --------- <br /> Final Ins ection b ----- <br /> P Y Date --- _p`� - <br /> . (JI <br /> SAN AQUIN LOCAL HEALTH DISTRICT I� <br /> E. H. 9 1-'68 R. I� <br />