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FOR OFFICE USE: `` � <br /> APPLICATIDN-POR-SANITATION PERMIT <br /> Permit Na. <br /> ............. -------------•-•---------- C 1 to.in��Trlpllcato) ,...,... .. <br /> ..........................••-----.-__-......---_.._...--- Hate Issued . :/.Y-: C <br /> /This Peje+blf fxph s 1 Year From 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 /> k described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulattiions: <br /> ��l�UX ---------------¢ .-.. ._.............................CENSUS TRACT ......._...fes ....._ <br /> JOB ADDRESS/LOCATION ...---•.._ `.... I--,--• X55 rN <br /> Owner's Name C -----•1_f ./�.Ns-•......................... ....................................Phone ................__....-......- <br /> _.... <br /> .................... <br /> ....... City ....mo .............. <br /> .. ........... <br /> Addre ...............•---...._.... --.. - . Phone ....... ......................- _.......... ---...License # .......Contractorfs Noble <br /> ---------•••- <br /> Installation will serve: Residence Apartment Ho use❑ Commercial❑'frailer Court 0 <br /> ` v Motel ❑Other <br /> Number of Irvin units.-'-.- Number of bedrooms -� Gdrba a Grinder Lot Size ....fa- -••:---•••--••-••••- <br /> u / Private ❑ <br /> Water'Supply:,Public System and name --------- ......................... ...••••..__.------.-_.........._...........--....-........... <br /> Character of soil to a depth of 3 feet: Sand 91 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan p Adobe 0 Fill Mcterlal ............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,[ r " <br /> PACKAGE TREATMENT [ J SEPTIC TANK I I size.......................................•--...... Liquid Depth -.....:141A.........--•ty <br /> rc CNsT CasM No. Compartments .... ...... pyo <br /> F Capacity _ 600.. Type Material.....---• -----• .....,._ <br /> Distance.to nearest: Well ........................--...........Foundation ....fP............ Prop. Line ....-�............. <br /> LEACHING LINE [ No. of Lines ------ •..--- Length of each line............................ Total Length ............................ <br /> 630 'D' Box ------- Type Filter Material ....................Depth Filter Material ._....__.....: .......................... <br /> Fi�1ex Distance to nearest: Well ................•_..._._ Foundation ...._...._._............ Property Line ...................... <br /> ................ o ❑ NrFE— G&f--H- ---------------- Oie�tete --- ............ Nae�eF . . . . <br /> 1. <br /> •,1 . Lw eept ---------- ---- .•..•••---- •- <br /> Reek-Sin <br /> i Distance to nearest: Well _---------_---- ------------•-......Foundation .................... Prop. Line .... ................. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -•-•••••------------------------------------ Date ......... ..--.------..---.---.I =* <br /> Septic Tank (Specify Requirements) ---•--------•--------- ........... ..............•••• ............................._.................................................. <br /> fl <br /> Disposal Field (Specify Requirements) --------_-------------------------- ------1=:,-..A........... ---------------..................................................... <br /> � <br /> --------------------------------------------------------------- ----------------------•------------------------------------------------------ <br /> ----------­---------------- -------- ••••------------------------------------_---.........•....... ---------.............-......-.........•--.................^....... <br /> _.� <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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 Ileen- <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 /> j as to become subject to Workman's Compensation laws of California." <br /> Signed /Y ,half/I�. -5`'-�•-------•-•-•••... Owner <br /> By -------- ---- ------------------------------------------ ----- Title --------_------ ------.... • --...._... ....-•----.. ...... <br /> (if other t a nerj <br /> FQR <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------------------------------------- -------- ........ DATE , _.,I!.._....... <br /> BUILDING PERMIT ISSUED --------------- ---------------------- ------------------_ -_-- ....................DATE <br /> --------------------------------------------------------------- ........................ ----•---- -----------..------------------ .................. <br /> ADDITIONAL COMMENTS <br /> -------•-•- ------ -----------------------------•--•-------------- ----------------- ------• -------------------�- -•- ---.---•..- <br /> i ---------------------------------------------- _. _ _ _______ ____-_.--_._--____._._.-----..........__....__-__.._____._..__..._. ._ .. _ ._..... <br /> Date . . ._. T 7 <br /> } Final inspection by: .. ,/ __------•-- - ---•••---------------------------------- ---- �,. ��_ .:. .� . . _.. <br /> Ell 13 2L 1-68 t v SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />