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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ...... .................•- <br /> ornple#e in Triplicate) Permit No. <br />.................. <br /> ...........................--- - <br /> This Permit Expires 1 Year From Date Issued Date Issued <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 ADDRESSAOCAT) N ..L.. G'. - .._. _. e�� .-�� .................... . . <br /> . ..� . ...�.... _: ._,.......=_ .....:...:........CENSUS TRACT,�-".e::.:"�:r <br /> Owner's "Name ... . �. �L,� 4.s� ' .Phone <br /> j <br /> AddressCity . <!�zata.; .-- ,.... � _.. .... `.. <br /> Contractor's Name' .__. ._,: ' <br /> -�,-� a- c=,... p..: . 3 Phone:............:...... k <br /> - "`.:_.::"_.License•# _ i <br /> Installation will serve: ----Residence:n Apartment House❑ Comml-❑ <br /> MotelTrailer Court a. I <br /> []ether ? <br /> Number of living'units:.-„ .._1._,;,-Number of-bedr-ooims.J4....Garbage Gentler. __._..:.-....;dot Size::....C'-���--� ?=:. ...... f <br /> Water Supply: Public System and name ..-- . Private <br /> Character of soil to a depth of 3 feet: Sand 0, iIt❑ Pay' ❑ Peat 0 Sandy Loam❑ Clay Loam: <br /> Hardpan Adobe F.ill Material _ .......... <br /> .. . If,yes; type _ <br /> i . <br /> (Piot plan, showing size.of.,lot_Icicoti.on of. system,in :relation..to..weiis,.buildings, etc ;.must. be..pfaced on reverse side,} <br /> �EW INSTALLATION (No septic tank or seepagespit,pgrmitted if;public- sewer is.avoilable w h in 200 feet,)' <br /> i = f <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' Size 5 :_ 1 a X S Liquid .Depth <br /> . ..... ..:. <br /> Capacity f,boo. Matterial <br /> � No Compartments <br /> t Distance to nearest: Well a. t . [ ' i <br /> : -.. _.. . ..-_••-:---Foundation f7 , -- Prop L rse _.---,-•...� 1, <br /> LEACHING LINE ,. ... _i <br /> I <br /> No. of Lines g <br /> k <br /> [ Len th of each Imefl Total length ..�._ ... ' <br /> l 'D” Boz ;�. Type Fitter Material 5 Depth'. Filter Mate'r`.i00 <br /> al 1. .:�f <br /> - ------------ <br /> Distance-to-nearest: Well �' ;"'Foundati 1 Q Property Line <br /> SEEPAGE PIT []�]� a..'Depth ! ameter ; --+� . Number _._ Rotk Filled! Yes IVa <br /> Di 4 n <br /> t 4, <br /> 1. Water ;Table, DeptF ...-- -•--::_--1CZRotk.Size. .. <br /> Distance to'nearest.: ------Well <ti7 b.--- Foundation - <br /> _,�_� Prop 'Line:,- <br /> -. <br /> R PAiR/ADDITION.{Prey. Sanitation:Permit# ---- . %._T _. :Date <br /> Septic Tank (Specify`Regvireinenfs) ,,:. . ..... . ........................ ...-- - _ 1 <br /> Disposal Field {Specify 'Requirements} -..... .------------­-------------- ...... ............. ... . ............... <br /> ........:.. ........ ......,.._..._ .. .__--___....._..._..'-. --------------._....... -----.--•.-- _.. ... ._....._. -------------- <br /> --------------- . <br /> _......_.._............ ........... ...................-_--..x-. --- -- ------_---- .._...----- __. ........ _-.. -...._.. _.._....___.. <br /> 9 <br /> (Dra'w existing and required addition on.reverse side).' . k <br /> 1 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, 6hd Rules :and'Reg ulations:aif the San Joaquin Local Health`District. Home owner or licm <br /> sed agents signature certifies the followings <br /> "I certify that in the performance of the work for which this:permit is issued,' I shall not employ anyperson in such manner � <br /> as to become subject to Workman's'Compensation I- mis'of California." <br /> ;.. . <br /> . . . a.t W Acte r <br /> ' <br /> Signed <br /> B - Title .;.,. ..,' ....... <br /> (If other than owner) _— FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y ...t �': ------ _. ... . DATE /./... L.a' ..�..: .._..:.•----- <br /> BUILDING PERMIT -ISSUED :: _. DATE <br /> . _.._........... ......:.................................... ..... ........ ........-.......,......, <br /> ADDITIC►NA! COMMENTS .... ...................... ------------_......;:..... ._..._,..,. ------------.......... .... ......................... ............... <br /> . . ---------- ------- ------------- <br /> •............. ... .................... <br /> ----------- ------ <br /> Final Inspection b ..... ...... ....................__... - ,/._... ` <br /> y' �-- - .• ......._.. _ .. •--••-_....._bate <br /> _. _.... . �_.._. _ . ; SAN JOAQLIIN LOCAL w HEALTH DISTRICT <br /> a <br /> F_ H_1.3 24 1'.•69 Rav- 5M .7/72 3 K <br />