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�. i <br /> FOR OFFICE USE: APPLICATION FOR SANITAMON 'PERMIT <br /> ------------------------- <br /> Permit No -- _,773 <br /> ---------------- <br /> (Complete in Triplicate) <br /> ----------- --------------------------------- <br /> _ 7,(,7f <br /> Date Issued ---/----------- <br /> ---------- ------------------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Son 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 Ruless*&T&Regulations. <br /> JOB ADDRESS/LOCATION ...... ------------------------ -------i---------------CENSUS TRACT ------- <br /> nOwner's Name -------- -6 0------ ----------------- ------------ ------------------------------------Ph ------------------------------ <br /> -7 <br /> Address ------- ----------- ------------------------------------------------------------_. City ------ ------z------------­----------- <br /> �r-71 <br /> Contractor's Name ----- -----------------------------Licensre -7---2...... Phone .151 <br /> Installation will serve; Residence [g Apartment HouseF❑, I <br /> ] Commercial railer Court <br /> Motel F1 Other -------------------------------------------- <br />`• Number of living units----- Number of bedrooms _3------Garbc�ge Grinder Lot Size ......... <br /> Water Supply: Public System and name CAPM_ ___-_--Private <br /> Character of soil to a depth of 3 feet: Sand'F] Silt 0 Clay E] Peat E] Sandy Loom -F] Clay Loam 0 <br /> Hardpan E] Adobe Fill Material ------------ 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 ------------------------ <br /> Distance to _nearest: Well --------------------------------------Foundation ---------------------- Prop. Line ---------- ------ <br /> LEACHING LINE No.,of Lines ------------------------ Length of each line--------------------------- Total Length ----------------------i...... <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 ❑ No <br /> Water Table Depth ---------------------------------=------- --------Rock Size --------------------------------- <br /> Distance to nearest: Well _____.___--______._-____..._T._._.RFoundation ----------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---_----------s____"-------------------- Date ----------------------------------- <br /> SepticTank (Specify Requirements) ------------ -------- --------------------------------------------------------------- -------------------6-•--------------------------_ <br /> Disposal lie)d (Specify Requirements) ----Xo6e,,&q ----- <br /> &_ %&�-e—---------pk4, ----------------------- <br /> ----------o a-a.......... ---------4'e'o-e-A-------oe�z— ____s l ------------------------------------- <br /> Alk— ...... -------------- <br /> re- <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 /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as tobecomesubject to W*rk'!nan's Compensation laws of California." <br /> Signed ------------------------ ----- ------- --- -------------------------------- Owner <br /> - <br /> By ----- ---------------------- <br /> ---------------------------- Title ------ <br /> (if other owner)- <br /> - .000 -- ----------------------------------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- -1_ 1'y;7----- ---------------------- ------------------ DATE -------7—(7_09---------------- <br /> ---- ------ <br /> -7e ---------- <br /> BUILDING PERMIT ISSUED ------------------------ ---------------------------I ---------------------------------------------------DATE -------------------------------------- <br /> ADDITIONALCOMMENTS --------------------------------------------------- ------------- -------------- -- ------------------------------- ---------- --- -------- ------------------ <br /> ----------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- - ------------ ---------------------------------------------------------------------------------------------------- <br /> -------------------------- -------- ------ __/------------------------------------------------ -------- <br /> --------------------------------------------------------------------D te <br /> _67-------------- <br /> --,n- -------------- <br /> Final Inspection by. a <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 T-'68 Rev. 5M, <br /> .A <br />