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FOR OFFICE USE. <br /> ...........11....... ............ .............. ----- APPLICATION FOR SANITATION PERMIT <br /> ................. <br /> ......... ............. lComplete In Triplicate) Permit No. .7 <br /> ............. ........................................ ... This Permit Expires I year From Oat*issued <br /> Dote Issued <br /> Application is hereby mode to the Son Joaquin Local Health District for a permit to construct and install the work <br /> herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations, <br /> t. JOB ADDRESS/LOCATio <br /> Owner's Name <br /> ..................................................CENSUS <br /> ............... ..............................CENSUS TRACT .......................... <br /> ... 4n,......;/�, <br /> Address 1-1 : ....I.....I...............................Phone W-3-:7A�C4,3�......... <br /> ........... 0-6-7-� atao <br /> Contractor's Name ---------- F..... .... . ... . . I. ...... . .......-,..........city .................. <br /> ..................-.License .... Phone Ak-7.& <br /> Installation will serve.. -�k-e-sidii-nc—eKkport—meni-No-us—eiTtEmm—eril-al�Effi-lI ' - - P-7.... <br /> 'r .F �--� a wc6uri <br /> Motel 71 . ther <br /> F t 0. ------ .......... <br /> Number' <br /> be� <br /> Number of living units --- Numb drOoms ... ....Go <br /> I rbage Grinder Lot Size <br /> Water Supply. Public System and name ........ <br /> ............ .........................W 11 <br /> ...................1-.................... ................Private 0 <br /> Character of soil to a depth of 3 feet. Sando Silt Clay F] `Peclt 0 Sandy Loom 0 Clay Loom 0 <br /> Hardpan El Adobe Fill M6terial .......... i f yes,type....I......... ............ <br /> ............ <br /> �Ve'lls building9l, etc, must b4 Placed an reverse side.) <br /> (Plot plan, showing size of lot, location of system In relotion'" <br /> NEW INSTALLATION: (No septic tank.-or <br /> --A"pqge,p.it-pormittbd.ifpublic,sew.er,is,.availobfe witl4in 200 feetj <br /> PACKAGE TREATMETg f SEPTIC TANK f I I <br /> Size Liquid Depth....................... <br /> Capacity ...... . <br /> J----------------- Type -------------------- Material..... NO. Compartments <br /> -Distance to nearest: Well .................... <br /> Foundation ......... Prop. Line ......I............... <br /> LEACHING*-INE -�flt+No of L- <br /> ane's -------------- ....... Length of each line.................... <br /> V Box J Total Length <br /> ....._..-•••................W...... Type Filter Material ..........4 Mat---------Depth Filter rial <br /> 11 <br /> Distance to nearest: We <br /> SEEPAGE t&,,-,i ..............*......... Foundation ................ <br /> �E PIT Dept 7 Property Line ......................... <br /> h . ........ ..... Diameter ................ Number ......................... Rock Filled Yes [I No <br /> Wat --TAII, Depth ----I------- --------------------------------Rock Size .................•.--..•-• <br /> T f I..... ...... <br /> Distance to nearest: Well ----_'_.... ......... <br /> r 1) ............Foundation -------I------ Prop. Line ..................... <br /> REPAIR/ADDITION tPrev.-So' nitationPermit# ....I <br /> .................................. -A 'Date ..................... <br /> Septic Tank (SpecifV 'Requireme'ntsi .... ... <br /> ------- ........... <br /> t R <br /> ......................*.......*------------- <br /> Disposal Field (Specify Requirementsi ....... .. ..... <br /> f -1 ------------------- ....f.........................*------------------------ <br /> % <br /> --------------•-•---••.-•.._............_......._. <br /> ----------------------------- --------- ---------------- ... ... .. <br /> ---------------- ------- ---- ---------------------- <br /> (Draw existing----a--n--d---required-addition-o-n reverse side)sid"e')...................... ....................*---------- <br /> -- <br /> I hereby certify that I 'hdjj� preppred_.this A <br /> Le� _*pp!lcatIonqnd.1thpt.th6 work will be done In accordance with San Joaquin <br /> County Ordinances, State 4ws, and Rules <br /> sod agents signature certifies.the following: and"Regulations of the San Joaquin Local Health,Dishict. Hattie owner or licen- <br /> N certify that In the perfornia <br /> nce of the work f4ir which this permit is Issued, I shall not employ any person in such manner <br /> as to become subject to Workman's ComPensati6n laws sof C`IiArni <br /> Signed .-------- <br /> ----------------------- <br /> ...... Owner <br /> By ................ <br /> ....... - -- - - ------------ --------I............. Title <br /> (I f 1�t h <br /> an owned/ ............. ......................... <br /> EPARTMENT USE ONLY <br /> _C <br /> APPLICATION ACCEPTED BY -7.. ...... <br /> T .j� I------ ........I-------- --------------- .......... D <br /> BUILDING PERMIT ISSUED ----- * -- - -- TE <br /> --- -------------------**----------------I-------------------------- T ........................................ <br /> ADDITIONAL COMMENTS . ------- ---- ------- <br /> -DA E <br /> .............. ................... <br /> --------------------------------------------- <br /> 01 ................ ...... <br /> ------------------ ------------------------------- <br /> .............. -------- V��4---------------------------------------------------------------- ....... -------- <br /> ------------ -- ..................................................... <br /> Final Inspection by: ..... --- --- - oe <br /> ......I------ ----------- -------- --- 0�0�' �71j. <br /> ,EH 13 2b :L-68 Date uo;/vo , --------- <br /> is <br /> ----SAN-, -1 -J,-0---A---Q-Ul-I-N---- 10---LOCAL HEALTH DISTRICT <br /> 8/7h 3M <br />