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FOR OFFICE USE: s <br /> . APPLICATION FOR SANITATION PERMIT <br /> ..................................- {Complete in Triplicate) Permit No. .................... <br /> 741 <br /> ............. This Permit Expires T Peat From Dafe Issued ^ Date Issued ......�"........:. <br /> —AOPIication 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 <br /> ..,..x,..�. .�, :.�.:....: ; . • ...- . _a-- �..._. . _'s. .._. s.--._ �, ._...CENSUS TRACT: . �......•--- <br /> Owner's Name o• . , `"•-........................... _..... ••..::............•-•--___.Phone <br /> Address -- city°.E'.... •- --. . __. <br /> -.. ........... <br /> Cop tractor's Name E;.F�.:_ t - ';; C as C <br /> 5:�:_/Jf..-.:. ._ ---- •--••--- .. _.License # 1.: 9 Phone . ..L .....�.`1..�.. <br /> In�tallotion will serve: Residence l2 Apartment-House 0 Commercial QTrailer Court <br /> 1 •.Motel d Other <br /> i of .bedrooms ..__.-. <br /> 9 � Garbage Grinder .__.---•--.. Lot Size. ---�--��-�•��------------------- <br /> Number of living unrtsc__....:.._._".Number <br /> WaIter SupI • Publip c'5ystem and name ------ -------- .......................--•- --- r <br /> Private.® y <br /> Character of soil to a-depth of 3'feet: Sand'13 Silt Clay Peat C3 Sandy Loom 0 Clay Loam <br /> Hardpan ❑ % Adobe [] Fill Material ---._.__..._ If yes,type ---_---------- <br /> (Plot <br /> _-_----•---:(Plot plan, showing size of lot, location of sysiem .in relation to wells, buildings, etc. must be place,mon reverse side.) <br /> NEW INSTALLATION: (No septie,tank or sp'epgge pit permitted if public sewer isavailablewithin 200 feet,) - r <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size__•_- ,.�-O.A.__.___�A1C........:..... liquid Depth -.�( °.,.l...:.. •--.. 1 <br /> V <br /> Ca <br /> . W acit` Type Material_Gt�_ . s � .......:.......No. Com drtment <br /> Distance to nearest: Well -----0_p........................Foundation ;L�.�.:' ":. prop.tine . ......... <br /> LEACHING LINE ( ] No, of Lines 2----_ Length of each I�ne.__ <br /> • '"!N gt r { <br /> 7 _-_......... Total Len th L2.�:..............� <br /> 'D' :Box __,_.........,Type Filter Material 4.'�-_&AAbepth Filter Material __�. ....................... <br /> ........ . . <br /> Distance to nearest:"Well i �_..,.: .. Foundation,� .............. .Pro artyLine" Sp..! , <br /> t <br /> { <br /> O Depth .,.�1�...:......:.. 19iarneter, - -- -•--•:--- Number -� ___.:-�.____ --.. Rock Filled Yes No {] <br /> Water Table. Depth ..:-.......Rock Size __�, -••-----••---.....--•--- . <br /> f t , <br /> Distance to,nearest: Well" _ .S_.D.---••--•......:..............Foundation 7S ............_ Prop. Line .5"10................. <br /> r .. ••--------=- - Date -•--.... .._. . _ <br /> REPAIR/ADDITION(Prev. Sanitation Permit#._________________':....... . _ . --_) <br /> Septic Tank (Specify Requirements} -----------------s...._ --------------- _ i <br /> .. . .. ._..--_-._.. ---- P <br /> Disposal Field (Specify Requirements) --•-•--••------------• ------------- ............................................................................. <br /> ...... <br /> Draw existing required addition <br /> . .. ---------------------- <br /> g and re q ddition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done yin accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health pistrict. Home owner or licen- <br /> sed agents signature certifies the.following: <br /> "I certify that in the performance of the worn for which this permit is issued, i shall not employ arse person in such manner <br /> as to become subject to Workman's Compensation laws of California:" <br /> Signed .... ::.._ <br /> �* D - ......... Owner <br /> BY , <br /> = ".:....:.. . =`::_;.• . .............. Title .....C_ ........................ .. <br /> (If other than owner) <br /> F R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ... `_.... <br /> BUILDING PERMIT ISSUED DATE ----- ..... <br /> „. <br /> DATE _!f..� 7L <br /> ADDITIONAL COMMENTS ..;...... ..__. <br /> _ ............................ ............................ <br /> .....:............ ......:..... <br /> -- . ....... --- - --•.............. ... <br /> _._..___ - .. ` __ _' ........................................................................... ............. If <br /> _. ........ .... <br /> . .... ....... . ....... <br /> °-- .. .. _ ... ------------ ....------....-' - <br /> Final inspection by: �_.... . - rD•_ � .............._..__-.__._................_..-•-•---._. ate._ � � : . .. <br /> ,... ;SAN.JOAQUINJOCAL HEALTH DISTRICT <br /> E. H. 13 -24 1-'68 Rev. 5M —- 7/72 3 M <br />