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T. <br /> - FOR OFFICE USE: <br /> - -' - - APPLICATION FOR SANITATION PERMIT------------------•---------- ---------- Permit No: 7,6-J <br /> (Complete in Triplicate) <br /> --_---_-___-___----------------------------------------I This Permit Expires 1 Year From Date Issued <br /> Date issued /0:7/'`"�� <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .Z/-4--- -I---- L- d", -----------------------------------------CENSUS TRACT --------------•----------- <br /> Owner's Name n3/Y1---'-- Q_ �lS�-------------------------------------------------- ------------Phone,-------------a------------- ----•---- <br /> Address aiv-- -----•-------------------------- i---------------- City - N/ea C ----- -.._...- <br /> q� Ev I <br /> Contractor's Name -!_"_l_ ---------------i4----� uA!� `if/{�---I-- License #� _ ---- Pf�one �a ---- <br /> -r- I <br /> Installation will serve: Residence [g Apartment House❑ Commercial: Trailer Court i❑ <br /> Motel []Other ---------------------------------- �. <br /> Number of living units:___ I-- ---- Number of bedrooms __; 1-_.Garbage Grinder ------------ Lot Size f_d Q__ _7- --------------- <br /> Water Supply: Public System and name ------------------------------- -----------------------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'2. Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> t <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- <br /> (Plot <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,) N <br /> PACKAGE TREATMENT f ] SEPTIC TANK:[ ] Size-__-- _ '-}!_ +0----- Liquid Depth -_ ------------- <br /> ' Capacity --.-_ Type pAe w"�Material dd"t2_ r�IQo- Compartments <br /> Distance to nearest: Well ----jc:� _/---_--_--_.- " -Foundation --------- Prop. Line --__ �___--_--_ 1 <br /> LEACHING LINE No. of ----- a� <br /> --..-. [ ) Lines �- ------------ Length of each-Iirre_____!_-6--------____-- Total Length ��[�-------_-__-- <br /> D Box Type Filter Material _ ---Depth Filter Material __l ---------------------------------- <br /> Distance to nearest: Well -------4M......... Foundation ...../d-/-.------ Property Line -�A............... <br /> SEEPAGE PIT [ Depth"'?---------.------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No C1 <br /> Wdter,,Teble Depth ------------------------------------------------Rock Size -------------- •-•---- <br /> Distance annce to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------- ....... <br /> i• <br /> REPAIR/ADDITION(Prev. Sant tion Permit r# -------------------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) -------- -----------------------------------------------------------------------------------.-----------------------------------------_-- <br /> Disposal Field (Specify Requirements) ------------------------------------ ------------------------ + <br /> ------------------------------------------- ----------- --------------- <br /> ---------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> i <br /> � 1 <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 Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature ceirtifies the following: i <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 /`7ff/Y�__ f .f� v�`7 =a°-------------------- Owner <br /> + i <br /> By ----- ,.� Title _ <br /> ------------------------------------- <br /> { fother than owner) �-. <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _.____ _ ._----. DATE __9 ���G <br /> ---------- ----------- ---- -------- - --- �- -- ----------------- <br /> BUILDINGPERMIT ISSUED ----------------------------------------------------------------------'-----------------------------------DATE ---------------- -------------------------- <br /> ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------------------------- --------------------------------------------• <br /> t <br /> --------------------- ------ --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ <br /> -----------------±------------------------- ---------=------- <br /> Cl----- - - - - - - - - ------ - -- ---- <br /> Final Inspection by- ------------ --L `---C1�--------------------------- -------------------------------------------- Date - .-----�, <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br /> 5 <br />