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FOR OFFICE USE: APPLICATION FOR SANITATION PERMI <br />...''.......... ..................................... Permit No. ..7`'.r....S.rs- <br /> (Complete in Triplicate) <br /> ........................... J <br /> ............... This Permit Expires ] Year From Date Issued <br /> Data Issued <br /> sflt ✓, - �r�1 0! f <br /> c2Y�-35 <br /> Application is hereby ma a to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is modpi in compliance withCounty Ordinance No. 55499 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION L�CAYiOd as .-yf71A) ... ..•� _-6XrX0:-?CCENSUS TRACT .......................... <br /> Owner's Name .......--- .......-•. .............................. <br /> /� -- Phone��- <br /> Address -..._...1�t r..... . ----------------- ....._....................... <br /> .. .. ... .............. City ........_..__...... ... <br /> Contractor's Name ......._.. .. _ . ...... . .... .............. . Licens;?Troiler <br /> # 1� -��e y. Phone .............................. <br /> Installation will serve: Residence [] Apartment House Commercial Court i❑ <br /> Motel ❑ Other ___ so " <br /> Number of living units:....-....... Number of bedrooms ............Garbage Grinder ............ Lot Size ----.---_---..__..------_._-.._.---_.-...... <br /> Water Supply: Public System and name -•---------------------------------------••---------- -__._ . - . --........... ------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy.Loam... Clay Loom ❑ <br /> Hardpan ❑ Adobe❑ Fill Material ............ 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,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK i1� Size,1 ...................... <br /> ...X � -X.��----- Liquid Depth .7 ............... <br /> Capacity Type ..-__ Material. .__... No. Compartments <br /> p Y Yp ....... �} <br /> Distance to nearest.- Well .... "M ___....Fou�`n/�dation ...__1f1 _ Prop. Line _..__.1' .. <br /> LEACHING LINE [� No. of Lines ------4P------------- Length of each line.__.T� .....__.. Total Length d.ZY........... <br /> 'D' Box .._�__ Type Filter Material ..._.XX.....Depth Filter Material --------/-7............................... Tn <br /> Distance to nearest: Well _. '`' ..... Foundation .....149.11 Property Line ..l. ._. __..... <br /> SEEPAGE PIT [k� Depth .. .- Diameter .eV��'... Number ____._. ................ Rock Filled Yes [ No <br /> Y <br /> Water Table Depth .........).1 14 4?. --------Rock Size <br /> Distance to nearest: Well ---- --------------Foundation .--,���. Prop. Line ..... ---.of <br /> REPAIR/ADDITION(Prev. Sonitation Permit# ------...._..----•.......................... Date _.•................................ 00 <br /> SepticTank (Specify Requirements) -------------------- -------•--- -•---.......-------- ..................... ............................----------.................. 00 <br /> Disposal Field (Specify Requirements) -----------------------------------------------------............................................................--•---------------- <br /> ---------------------------•----------------._.............------•_...._...•-------•---------................••----------_... ................•........................... ....... -•••--•-•------- <br /> .......................................------------------------------------------------------ ---............................................................ ....................... <br /> (Draw existing and required addition on reverse side) <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 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 become subject to Workman's Compensation laws of California. <br /> Signed ---------------------------- /. . ............................ Owner <br /> BY -•-•----•....................... .......... title ....lu�c�c.. �---....---...........------•-...•.-• <br /> (if other than owner} <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...._..._. r............. --------------------------- ....................................I DATE ....... <br /> ......�.. -----°. .................BUIL <br /> NG <br /> .. <br /> TONAL COIMMENT5 .LQIJ. .. A� - .ATI: -----...•-__-• <br /> / ----------- - .... - <br /> ................................... ...................................­.Al------------------------------....................................................• ....................... <br /> .f' ... . <br /> . ............ .................... ......... ............................................... <br /> : .......-....... -- .................. :::7. ' <br /> FinalInspection by: _..........G/7............ .................... ................................----...........-••.............----Date .... . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT CO <br /> E. H.13 24 1-'68 Rev. 5M 7/72 3 m <br />