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.) <br /> FOR OFFICE USE: APPLICATION FOR.SANITATION PERMIT ?S� <br /> c <br /> G <br /> ..................••-.. Permit No. ..73~... ....-. <br /> (Complete in Triplicate) <br /> ............................................... <br />.. - bate issued ...�.�--�••• <br /> This Permit Expires 1 Year From Date Issued <br /> ................... 0-70 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is m e1 in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> Y <br /> c7�i; n3c- a / �/ <br /> JOB ADDRESS/LO TION NSUS TRACT <br /> .4. LLG!.�.N_C-�. _ ( .........� .-......._ .- .Phone <br /> Address <br /> Owner's Name 1"�'a---•••• <br /> +v ............:........... <br /> y <br /> Contractor's Name -.--. -- se #�.713.-�-S.: Phone .. `� .Z • <br /> Cont . ...- •••`� ----- •--- <br /> Installation will serve: Residence partment Housed Commercial <br /> Cont {]Trailer Court 0' <br /> f <br /> Motel ❑Other ......................... .................. <br /> Number of living units:....-:...1 Number of bedrooms _....- _Garbage Grinder .�� Lot Size <br /> - <br /> Water Supply: Public System and name .... ...- ` +„1 ,', ----- ._---------------------------------------...Private 0 <br /> Character of soil to a depth of 3 feet: Sand'O Silt❑ -Clay Peat d Sandy Loam Q Clay Loam ❑ Y <br /> 7- If e ....------•...... ..........} <br />• Hardpan ❑. Adobe Fiil Material ./.};1 � . yes,type •�, <br /> Plot plan,-showing size'af lot, location of..system In relation to wells, buildings, etc. must be placed on reverse side.) CbV <br /> J1 <br /> NEW INSTALLATION: (No septic tank or seepage pitpermitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT '( ] SEPTIC TANK �� Liquid Depth <br /> ize.___.. ... . --.-.-. q p �......_.. <br /> r'Capacity <br /> Compartments <br /> � �Dis to� Type •- -- -••-- - ° �.0 �..,.,..- .r <br /> _. f. <br /> nearest; Well .......�. .._ <br /> - Foundation . -------•- Prop. Yne ............. j <br /> ! - <br /> LEACHING LINE [ No. of Lines -.-..-i ... ------ Leng# of ch line..--( Total 'Length .............. 1 <br /> Y. 'D..Box_.,- ..- ,-,',.Type.Filter_Material_... <br /> Depth Filter Material -----�y-.(• <br /> �l a <br /> a istance Nearest: Welllr &Xf. <br /> . .... Foundation ...,/-�._�._..-._ Property Line ................. .. <br /> , ...--._... Rock Filled Yes -�Dlo 0- ;.�SE� DepthNumber -----.. .-.Ed tk,pS, +�. r Water Table Depth <-P••. Rock Sixe ..._. Pr Lme -+ - ...� i <br /> .. -- / '1 <br /> Distance to nearest: Well .....,ill •-•...............Foundation --./...�--..._...- op. " l <br /> ` REPAIR/ADDITION(Prev. Sanitation Permit#.---..........--- --• .•............ Date _---------------- ------- ---- ) <br /> k Septic Tank (Specify Requirements) ............. ------------------------------------ ........... <br /> Disposal Field (Specify Requirements). ......... ... .. ------------...-----------.-_--------............. .............. <br /> ------ - ---------------- ------------• ------------- ------- --_... -•••--.....------I---•-----------------------•--------------- -------------. -•---------- --•--..._...... <br /> R ' _ ................------- <br /> ------------------------------------------------- <br /> ............ <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 licew <br /> F sed agents signature certifies the following: <br /> ' "I certify that in the performance of the work for which this permit is.issued,1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of. California." <br /> Signed .................... .---------.:.­------------------ . .... Owner <br /> �-`t! _ <br /> i <br /> B Title ... .....:............. <br /> ::. <br /> By ............ . : <br /> (If oche�tr'`ha ne.r). ,�-' `�-_ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... .--- --=-=-- <br /> -- - - ---------------------. ........................ DATE .--.d0•. _-..._..-... - ---------- <br /> BUILDING PERMIT ISSUED :----•- :: --•- -- = .....DATE ... <br /> ADDITIONAL COMMENTS <br /> 7., � i <br /> = - <br /> = ............................. ..... <br /> --------------------- --- _- Date -- <br /> Final inspection by: •- =-------------- <br /> F r.-•�"" ;Pa,•,.„z ._SAN-JOAQUIN 'LOCAL HEALTH DISTRICT <br /> — 7172 3 M <br /> ., <br /> 11 2la• •co o_.. Kar -- __-- <br />