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FOR OFFICE USE: <br /> I� APPLICATION FOR SANITATION PERMIT <br /> " Permit No: _L.__ _5_° <br /> (Complete in Triplicate) <br /> ------------------------------ -------------- <br /> . Date Issued __.__- _�'_�1.i <br /> _ --------------------------_-_-----------_---_--_- I This Permit Expires 1 Year From Date Issued a <br /> Application is hereby made to the S n Joaquin-Local Health District for a permit-to construct and install the-.work herein r" <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ` I ----rn--� ----- ------------------------------------ CENSUS TRA T ! 1 <br /> JOB ADDRESS/LO IO x6 <br /> �`` <br /> Owner's Name ._ <br /> ��1 �---- -� -'---- --�`�'--�-)"_�?�?�D�.�---------- -- - ----------------�-----------.----;--Phone - -�-�:"�-f�-{---- ---•- '3 <br /> Address ------------ � � �� l' -- ----------------- �0-Q_7�- Q ------------- . ----....----- > <br /> ------------------•--- City ------ ' <br /> ---------------------- <br /> Contractor's Name ------------ -----------C' --------------------------------------------.License # ------ ---- Phone ------- <br /> fi <br /> Installation will serve: Residence 4 Apartment House❑ Commercial ❑Trailer Court,',❑ <br /> �) Motel ❑ Other -------------------------------------------- E. <br /> Number of livingunits: <br /> � � <br /> ! Number of bedrooms __._.Garbage Grinder ___________ Lot Size k______________ <br /> Water Supply: Public System andj name ---------------------- ------------- -------------------------------------- ,----- ------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> I! Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ___________________________ <br /> (Plot plan, showing size of 'lot; j(location of system in relation to wells, buildings, 'etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septi1 ;1c tank or seepage pit permitted if public sewer is available w4hin 200 feet,) , Z \ <br /> I <br /> PACKAGE TREATMENT• SEATIC TANK' Si��________________I___.______. _ q p " <br /> Ca acit �y" Typ �-R,7_-{°r�"_ Material_ 4 No. Compartments ______.P_--._ ----_ <br /> P Y <br /> Distance to nearest: Well ----_____eO__ ___________Foundation _.__�d_____ _____ Prop. Line _____________________�� <br /> �a� <br /> .nes._.=-.-.,_.�-_•--.__. Length. -each-lin -_�_��_��__--_Total Length ---------------------------- <br /> LEACHING LINE NDo.B x* - ly �� ���-� s A r �. <br /> "� e th Filter Material l ____________________ <br /> _. t----- Type Filter Material -- � --- - P 1------- <br /> Di stance <br /> to nearest: Well FNumberon Rock Property Line. - <br /> D - <br /> Diameter ck Filled Yes No <br /> SEEPAGE PIT [ ] Depth ___ - I f <br /> ❑ ❑ <br /> Water Table Depth ------------ --- ------- --------------- ---Rock Size ------------------ -------- # <br /> Distance to nearest: Well -----------------------------------------Foundation ---------------- ___ Prop. Line _ ___... ------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------------------------� -}Date --- -"-- ------------,----- _---1 S <br /> SepticTank (Specify Requi er ments) ------------------------------------------------- ---- ------------------------------------ --------------­---------------------------- <br /> J I <br /> Disposal .Feld {Specify Requirements) .- ----- t --`-------•----------- <br /> ------- -------------- <br /> I <br /> --- ---------- ---- ----------------------------------------------------------------------------------------- ---------------------------------------------------------------------- ------------------- <br /> (Draw existing and required addition- on reverse side) k a <br /> I hereby certify thathave prepared this application and that the work will -be done in accordance with San Joaquin <br /> County Ordinances, S Laws, and Rules and Regulations of the San!JoaquiniLacal Health District, dome owner or licen- <br /> sed agents signature ce fi s th following: <br /> "I certif th t ' he anc of the work for which this permit is issued, I shall riot employ any person in such manner <br /> as to bec t o an's Compensation laws of California." <br /> * � r f ! <br /> Signed ------- O <br /> - --------------------------- wner 1 <br /> L <br /> �p ���TMENT__USE <br /> ------------- Title ------ ----- '-- --- - ----------------------------------------- <br /> (If other t a wne`'r) <br /> I! ONLY i ) <br /> APPLICATION ACCEPTED BY ---------------------- ---- DATE <br /> �I <br /> --- --- -- - -- - <br /> BUILDING PERMIT ISSUED .-_-----il _ _ __-- __-- F----------DATE ---------------------- s <br /> --- -- -- ------- --- -------------------------------------------- <br /> i ADDITIONAL COMMENTS - - = - ==-=--- ---- --------- <br /> 4-7-71 <br /> ------ -- - <br /> ___ �`�'� r c i ------------- <br /> ----------------------------------------- - ------------------------------------- ------------- --------=---- --------------------------------------------------------- <br /> ,I f --------- <br /> Final Inspection by: . -----------------------------Date ------- <br /> ---- ------ <br /> - -- ------------- -- <br /> �i <br /> AN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6B R M Vii , ' <br />