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-„ FOR OFFICE USE: <br /> :- APPLICATION FOR SANITATION PERMIT <br /> - �. <br /> Permit No. � T 0 <br /> --•-..................... <br /> (Complete In Triplicate) _.. <br /> This Permit Explres_.1 Year From Date issued Dote Issued............. <br /> i ..............................•• ...-_.__--..---•- _.i - <br /> Application is hereby made to the San Joaquin Local Health District for q-pexnait.so-constrctnd-ittaY+�tte `work herein <br /> described This app�cgtiQm.isaade,i 1 ount Dr nance Na. 549 and existing Rules and Regulations: <br /> - t <br /> 91'59 Co ................ ................. J........................ <br /> Owner's Name ....................Walter A. Locke Phone 47$-6911 <br /> Address .........915L9--•Co.nnie._A•ve ............................_ ................... ... _T .. . ... ._.-........... <br /> ----- I«ity-..». 0�1. <br /> Contractor's Name --------- wneP-builder Lirettse -4--, } .... Phone <br /> -•••• <br /> Installation will serve: Residence *+ortment House <br /> fl Commercial oTrallee Court �_:.�•- . <br /> € Motel E]Other ---- . ! <br /> _r <br /> Number of livin u.its 1 <br /> g _.Gbrbage Grinder x t Si ,.One�fkcre <br /> ................. <br /> Water Supply: Public System and name - Size :• •• <br /> 1 <br /> -- �' Private <br /> Character of soil to a depth df-3-fe�t: Saaa-4 -.- <br /> 0- °Silt o- C#ay Pact SaDdy Loam 0 Clay loam ❑ <br /> /Natyer�lak.XO.. If ye type ............... .... <br /> E "•s _ J ! - <br /> {Plot plan, showing size of lot, location of system Ip relation to wets, buildings, etc;” must be placed on.reverse side.[ <br /> NEW INSTALLATION: (No septic tank or seepage rt' t- <br /> - p # P P + ed kif pubft�,TdWMs available within 200 feel <br /> PACKAGE TREATMENT [ SEPTIC TANK f 3 ....... Liquid Depth....---...---.:_..........__ <br /> 1 Type -"' fie`ri�l _._._...-. . No. <br /> Capacity T e r <br /> • ...... No. Compartments <br /> Distance to nearest: Well ----••---• ---..._.� �:: F ndation ............... ....: ') <br /> rgop. Line <br /> LEACHING LINE [ ] �..LL ' <br /> No: of Lines 9 - "` . <br /> L�en th of edch lin : :....................... Total 'Len th ....... <br /> 'D' Box Type Filter Materia .Depth .lifter Maters <br /> �__.,.. <br /> 1 . a. .Lz . <br /> Distante to negreSt Well ........................ Foundation � __._. Proper Line <br /> SEEPAGE PIT ,4 .. <br /> [ Depth __ ------ Diameter ---------------- umber ' -.--_ Rock Filled Yeses No <br /> 4 <br /> • ,. ..................... <br /> Water Table Depth '---------•-•-------------....•-------- ocli Size ._...... , <br /> Distance to Barest: We :_ �w: F'N ation - <br /> .. -- ...._ Prop. Li <br /> REPAIR/ADDITION(Prev. Sanitation Aermit{# _...__.__$.--_--.._. �: - 7 <br /> O <br /> Septic Tank (Specify Requirddli!( (JF <br /> Disposal Field (Specify Require eats . <br /> ------ .�- �-_--=�---------------- -- <br /> ----------•-------------- -•-.- ► <br /> ---•-•-----•--------- --------------------------- -- r------------ = ------- ------ _ ..... ..... <br /> -------------------------- -----------------•--•••---.... <br /> (Draw existing and required addition on rbverse side( <br /> 1 hereby certify that I have prepared this applicatia ctind that the work III be � nes-in accordance with Sten Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Jo04uin local Ith.District. Home owner or Ilcen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which then- snit [is �- <br /> w= W Nl shall not employ any p:kon in sus"'(manner <br /> as to become ��subject to Workman's Com �nsa ' n laws of Cal+fo��." , d <br /> Signed -------(�C/ 0_.c-- ---- ----j 49whe� <br /> By ------------------••-----------...._..._- •�, It e <br /> (If other than owner) <br /> _ FO EP RTMENT USE ONLY <br /> APPLICATION ACCEPTED B ---._...__ DATE .. .. <br /> j ... 19 14 7 <br /> BUILDING PERMIT ISSUED --------------••-------... • - _ l <br /> ADDITIONAL COMMENTS ------- <br /> ------------• --------------------------------- ...._ ..-----DATE ................... • <br /> ----- <br /> --------•---------------- ---•------ <br /> ------ --------------------------------------••-----••- ---------•.----._............ <br /> Final Inspection b _ _ _ --- . <br /> P y: .. • Date _._...-. ...___..__. <br /> EH 13 2h 1-68 Rev, y SAN JOA tttN...L....._.. <br /> Q OCAL HEALTH DISTRICT 8/7h 3M <br />