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FOR OFFICE USE: <br /> 1 APPLICATION FOR SANITATION PERMIT 30's <br /> ............... •...._.. ---------. ------ Permit No. .7.`�.._.._..... <br /> {Complote in Triplicate)I#q <br /> ...................... This Permit Expires 1 Year From Date Issued Date Issued .`�:•1.�.._..:. <br /> k Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described T 's application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> l ;L, ��3 HY r r °�ac� ;5 W�' Lookfiard)C <br /> JOB ADORE S/LOCATION ........ .. :. <br /> " ._..:.. .................'Or... ENSUS TRACT ..............:.....:....: <br /> 'Mr, nosier one <br /> Owner's Name ..............................:............................•--........._..:.......----.....-----------•-• <br /> .............:.........Ph .._727,-.5.3.1-5........... <br /> Addressm..........1.9_8! •RI- asPn •-----• ..................... Cit <br /> .......... k . ......................•-•-----..._.._._...:............ <br /> F Contractor's Name .........RZaekard-'-s..3P_pti.E.--'dank.................. . .License # ...._....... <br /> Installation will serve: Residence ❑ Apartment House Commercial ®Trailer Court 0 <br /> Motel ❑Other ............. .............................. <br /> Number of living units:............ Number of bedrooms ............Garbage Grinder .......... Lot Size .... F..qxq gS.........:.... <br /> Water Supply: Public System and name ........................................ -----._...._a fl ??. ..: x 57.x........................Private ❑ <br /> Character of soil to a depth of 3 feet:_ Sand❑ Silt❑ Clay ❑� Peat❑ Sandy Loam ❑ Clay Loam❑ <br /> I Hardpan Adobe f] Fill Material ............. If yes.type ............................ \� <br /> (Plot plan, showing size of lot, location of system in relation stcr 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,] <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ Size..................... ....... Liquid Depth ..-....................... _r <br /> - T <br /> Capacity .................... Type Material...................... No. Compartments <br /> .e <br /> Distance to nearest: Well ....................................Foundation ---------------. ..... Prop. Line ....--------.--......? <br /> LEACHING LINE [ ] No. of Lines ....... ............... Length of each line............................ Total Length ............................ <br /> 'D' Box ..__........ Type Filter Material _:..................Depth Filter Material ..............._.___.._._.__...... ....... <br /> Distance to nearest: Well �...._............... Foundation ..... .................. Property Line ....... ................ <br /> I �Depth p .................... ..._.....Rock Size ------------------------- Filled Yes [3 No <br /> SEEPAGE PIT j j __------------- --- Diameter Number ..__........ ...---_---- <br /> ... Roc <br /> Water Table De th <br /> ► Distance-to-nearest; Well .................... ' .._ .....Foundation ......................Prop. Line ....................... <br /> ......_..____• _. <br /> REPAIR ADDLTIO Prev. Sanitation', # ............................................ Date .................................. <br /> Septic­Tank,(Specify Requirements) ...................-..-----------�- - s------ <br /> ....----.�......-----•------•-------------• ------ � .: <br /> "` "' Inst-all -----•-•`N ' <br /> Disposal Field {Specify Requirements) __ atYsOh..Li7e.. .._ 1�.- --- ..._..._.... <br /> t, <br /> ani: �Q_Qk�..�. ' :. ,�.--..�._ ,�..... �..w_ . ....__,,_, <br /> x _.t_Q_.. r k. `----------------------:.:-----------------------......:....._.._.._.. <br /> ............................................ ............................................................------------................._.:_.__.....-•---._...._.....-........._......................... <br /> (Draw existing and required addition on reverse side)4, 74r k <br /> I 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, and Rules and Regulations of the San Joaquin Local Healtg'Dlstrict: Home owner of lice"- <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 /> I as to become sublect to Workman's Compensation laws of California." <br /> i <br /> Signed ........... .................................... ....................._.............4.L.......... Owner <br /> A <br /> '. <br /> _ B_il., ...al@;Qxax' ......................... Title .. Co, eta ... <br /> By (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> .................. <br /> . ._........APPLICATION ACCEPTED BY ............ DATE .` <br /> BUILDINGPERMIT ISSUED ........................... .............................................................:---4..............DATE ........................................... <br /> ADDITIONALCOMMENTS .....................•----................------------------.........................-_......-----••---._..._............._.............__._._....-•-.._._...._ <br /> ". .............................. ........... - -•-------•--az,;...................................................................................................................................... <br /> :._..... --------- -- - -- <br /> Final Inspection by:,_. .. .. ....�. `^� to .... t ........ <br /> Da - .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT IIII <br /> E_ F{ 13 24 z.'ba Ran_ 5M <br /> 7 1.7 2 3 X <br />