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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 10/4/.................. L1..'..14.... Permit No. .7..c :��5.... <br /> (Complete In Triplicate) . <br /> .`. .......................................... This Permit Expires t Year From Date Issued Date Issued l6"........... <br />` Application is hereby made to the San Joaquin local Health District for a permit to constn;t and Install the work herein <br /> described. This application Is made in compliance with County Ordinance No. 549 and existing Rules and Regulationsr <br /> 4 <br /> 4 JOB ADDRESS/L ON .. <br /> ...... ._ .......................CENSUS TRACT ... :.. <br /> Owner's Name . -••••-••-- r - ........ ... ..... r. .. ..Phone .......... <br /> Address ..C.t...... ........_ ....City <br /> Contractor's Ncim�: ': s ... ..:. License #-RZ .. Phone .y�.S'i��/�--- <br /> installation will serves Residen"PfApartment House Commercial flTrailerCourt 0 <br /> Motel ❑Other <br /> Number of living unites--- Number of bedrooms .x2l Garbage Grinder ............ Lot Size .C!......... ..... <br /> Water Supply: Public System and name ..................................... .................. ...................................................Privatex <br /> k Character of soil to a depth`of 3 feet: Sane)0. Silt❑ Clay ❑ Peat[] Sandy Loam❑ Clay Loam ❑ <br /> HardponA Adobe Q Fill Material ............ If yes,type............... ............ <br /> (Plot plan,•.showing-size.of•lot,.location of system in relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: [No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> F PACKAGE TREATMENT [ ] SEPTIC TANK f 4l, Sit &, C .............. liquid Depth <br /> I Capacity Q •-•-- Typep Material. X,<- ...... No. Compartments ... . ..+.sem. <br /> I <br /> Distance "to nearest: Well ... .1 .p.R...................Foundation�. ..�j� -.--. Prop. Lina .��.. <br /> Of <br /> k _EACHING tINl: [` No. of lines .-..- ............. Length of each line.. �Q............ Total length `/.. 4'.......... .� <br /> T __'D',Boi.......r.... Type Filter Material '..Depth Filter Material .-. .�Y ........ .. ...... <br /> w <br /> Distance to nearest: Well Foundation ..I ................. Property line ..�?. .� . .rn <br /> SEEPAGE PIT [ Depth ..,92.5........ Diameter _.4a3 Number ........ :.......... ..... Rock Filled Yes No <br /> Ole <br /> M Water Table Depth .... .. .... . .................Rock.Size_ //.. ..............._ . f <br /> ` Distance to nearest: Well •- - .....................Foundation .C,i:?.�2.......... Prop. Line . ............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ................................ .I <br /> SepticTank [Specify Requirements) -•......................................... ............................................................................_............. <br /> DisposalField ISpecify Requirements) ----•-•---....---•--....---•----...............•-----------..........•--............................--•---.....................--•---• <br /> .....--.•------•-------------------- ----••--•--....-•--••--•- --•--.._...........--....----•-.............----------......................-•------...----------•-....................._...._... <br /> i <br /> (Draw existing and required add itlon on reverse side) <br /> f t hereby certify that. I have prepared this application and that the work will be done In accordance with Son Joagvhi <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 to bee* ;%,dect to Wo an'som ensatlon laws of California." <br /> aanee -•• p-- .........../....... <br /> •---�...... ........................ Owner <br /> By ................. j ..G��. •----- Title ......._...�..c.....:.................................•-............. <br /> [ off -ther than owner) <br /> R PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... ...... .- . DATE _ <br /> BUILDING PERMIT ISSUED .....- . , <br /> . . ........ . ... :..........................................................................DATE-..........................-......._...--.-. <br /> ADDITiONA COVA E}VT5 .. .............................................................. ... ....._ <br /> .. ... . <br /> /....................I- ------ - ---- - ------- - --------•----------------------------------------. . ...... <br /> .. .. .....--•-•............ .... ... <br /> Final Inspection by:` ...........Date . -........ .. .............. <br /> '-N JOAQUIN-•-•-'••.................................. .. rrQ ����(j <br /> { EH 13 2h 1-6h ... 2. s <br /> LOCAL HEALTH DISTRICT 8/74 3M <br /> I [[// <br />