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FOR OFFICE USE: <br /> 70 <br /> APPLICATION FOR .SANITATION PERMIT <br /> ---------=--------- --- --------------- (Complete in Triplicate) Permit No. <br /> This Permit Expires i Year From Date Issued, 1 � Date Issued 5:70 <br /> Application is hereby made to the San Joaquin Local <br /> •1HeattFlDi• rict orr pa -permpt-to"c-O istruct-and jin`sttill�-the work herein <br /> described. This.application is made in compliance. with County Ordinance No. 549 and existing Rules and Regulations.. <br /> he: <br /> --- -e--tom S-7---------------- <br /> ADDRESS%LOCATION .0? - �� <br /> } __ CENSUS TRACT - - <br /> Owner's Namj <3r, - rr' <br /> �, ---- ---------- <br /> Address -----%56. "TJ .1 - --------- hone -------------------- ------­-------- <br /> - <br /> - --- <br /> - P <br /> ------------------------------ <br /> =-- ------ City - <br /> Contraetor's Name -- . � , :� •--------- <br /> -------� -------------License # V/7.9. ,_ Phone <br /> Installation wil serve: Residence;gApartment House❑ Commercial[]Trailer Court <br /> Motel ❑Other ---_- -- <br /> Number of living units:___ Numbeof bedrooml_- <br /> ___--Garbo a Grinder _ " - ' <br /> 5 /�! IrLot Size <br /> Water Supply: ublic System and name __�_ " ---- <br /> ._[a � - -- <br /> -------------------- <br /> Character of soil to a depth of 3 feet: Sand Silt C!a <br /> ❑ Y ❑ Peat❑ San y,Loam ,❑ Clay Loam ❑ 4 <br /> 2_ Hardpan ❑ Adobe Fill Material ------------ Dyes, type ------------------ <br /> (Plot plan sho Ing size of lot, location of system in relation to wells, buildings etc, must be placed on reverse 'side.) i <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer s available within 200 feet,! <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' <br /> [ ) Size--- ---------------.,. - ------ ------ Liquid Depth ........... ------------ <br /> �r <br /> 1 <br /> Capacity -.. Type -------------------- Material_ --- <br /> ,,------------ No. Compartments ----f__�------_-:--- <br /> Distance to nearest: Well -------- - -- ------- -----------Founci'ation _ -------- ""_-- <br /> LEACHING LINE: Prop. Line "_----- ------- <br /> [ ] No. of Lines ------ <br /> - - Length of each line----lY '------------- Total Length _ --•a------ <br /> D' Box Yp -------- <br /> 13 T e Filter Material/�_/L0VX/�_Depth Filter Material _ <br /> Distance to nearest: Well .__- " �"__._ Foundation F , <br /> - ---------- Property Line _ <br /> SEEPAGE PIT [ ) Depth -s _--------- Diameter � c.--- Number'____.!"_- _-_ Rack Filled Yes ( No .❑ <br /> 4 Water Table Depth ------- ----------------------------------Rock Size <br /> `; , t <br /> Distance to nearest: Wel! "'-- <br /> ---------- -------------------Foundation --------- Prop. Line ------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------------- <br /> Date <br /> .,,Septic } <br /> Septic Tank (Specify Requirements) ---------------------------- r !, <br /> Disposal Field (Specify Requirements) ------47dr/c ` �. <br /> ------------------ ------=-------------------------------- <br /> .} '1- IV+ ---------- ------------- <br /> --------------- -----f- - ---_ - <br /> /� <br /> (Draw existing and required addpt�on on it <br /> side) <br /> I hereby cerci that T hrive prepared this application and tha�t�,�the work will exdone�inraccordance�wtth San Joaquin t <br /> County Ordi "nces, State Laws, and Rules and Regulations that the <br /> San Joaquin Local Health District. Home owner or liven- <br /> sed agents sigriiature certifies the following: + <br /> 1 certify that in the performance of the work for which this perfilit i sued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California <br /> signed ------------ <br /> -------------- ----- - ---- -------------------------- Owner <br /> 8'y ------------- ------ <br /> ----------------------------- Title ., <br /> (!f oche an owner) f ------ <br /> FO DEPARTMENT USE ONLY <br /> BUILDING PERACCEPTEDB . <br /> APPLICATION <br /> MIT ISSUEaFt- ------ ------ - DATE _ ------�Rz-�'._�7�--- <br /> D!TlONAL COMMENTS----- ------- ---------- --DATE 1==- -------- -------- ---------•-------:� , <br /> 4-------------------- <br /> ---------- <br /> - ----------------------------------------------------------- - - <br /> --------------------------------------- - <br /> -- <br /> --- ---�! __ <br /> --- ----------------------------- ---------------------------- --------------------------------------------------------------------final Ins ection bY - ------------------------------------------------------------------------------ ---------------------------Date -f1------ -7 <br /> --=------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ` <br /> E. H. 9 1•'68 Rev. 5M a, <br />