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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .........................._. . ���"� ---•- Permit No ..74`50 j <br /> i.- es�p . <br /> (C <br /> lete in Triplicate) • <br /> .-. <br /> ,.... <br /> ............................... .._._..., <br /> .. This Permit Expires 1 Year From Dat*Issued Date issued .................... <br /> I <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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: It <br /> JOB ADDRESS/LOCATION _..l..v.. 3....... .F;4. . ...... ..................CENSUS TRACT .......................... � <br /> Owner's Name C ----- _ ....................................................................Phone ......... ,......................... <br /> --.- <br /> Address . _ ---�-�..../..'1.. _._..- +-��J-J✓ ..---�------.---i..._........... City .................................... �. <br /> Contractor's Name .- .SL. yl .. nse 3#a� M P o �Z <br /> tristalfo"tion will serve: Residences i4parfinenf Ho ff Coinrrier a� raiier�urt_� <br /> F <br /> Motel ❑Other <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❑ Gay ❑ Peat❑ Sandy Loam ❑ 60y Loam ❑ <br /> Hardpan ❑ . Adobe 0 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'ewer is available within 200 feet,) <br /> PACKAGE TREATMENT �d SEPTIC TANK{ ] Size._. -•- .-------•-- liquid Depth .. ................ <br /> I ; <br /> Capacity Type ------------------_ Material....._ No. Compartments .......... <br /> /�`� s1 �.... <br /> LE ACHIDistance to nearest: Well "--- ---��. ............Foundation 0.�. _...... Prop. Line ...-_,.._........ <br /> ING LINE /[I No. of Lines .�............... Length of each li?e-. 7 ._. Total Length- . <br /> ength ....o��.�...�..... <br /> lr _` <br /> D' Box ..-- ----- Type Filter Mater i�sl ..•%l- De thtFitter_�- .Mate rai ...... ..�9.....•_._•__�------------- <br /> Distance to nearest: Well _.dC)_/.74..... Foundation � �� � "� <br /> SEEPAGE PIT j Depth . ."7°" ^'^^�Diame#er _______________• Number .......4� c---••--•----•-- Rock Filled Yes [3No t'❑ <br /> _- <br /> Water Table Depth .-------- --•--------------------- -----------Rock Sizer•-•---. •.... <br /> . - ,..._. Distance to nearest: Well ----•----•_.......__...__� _..____,_Foundat on .... .. . .......... Prop. line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Pee 4t .....................1.-.....1.1-- --- Date --_-•.... ...............I 1 <br /> Septic Tank #pecify Requirements) ---•---------- ---------------�...... ..........I----------- Y­­­­f ..............._..._.,...................... <br /> ...... <br /> P 11 <br /> P I P Y q + +f! ....... --------------------- <br /> Dis osal Fie 5 ecif Re u'rements) _____.=: �,_._ ..._ <br /> -------------------------••------------------------ -----•-•----- <br /> ----- •----- ------------ ----------- <br /> turd-„existing and equFred addition on reverse side) <br /> I herel yd:ce..tify that I have prepared this application:and'that the work will be done in accordance with San Joaquin <br /> y Or <br /> Countdinances, State Laws, andtRules•and.rRegulatip of the San Joaquin Local Health,District. Home Owner or Ilcm <br /> sed agenti signature ceftifies file foilawing: TM <br /> "I serol{y'that in the performance of the workJ.dr which this permit is issued, 1 shall not employ any person in such manner <br /> 4 <br /> r. as to bec � e subject to Wnrkman's�•Compensa#ion� Idws of California.” <br /> Signek ----------------------------- ------------------------------------ ------t Owner <br /> t �; <br /> BY ...a+ ! Title --- ......... . r- _.. .._. <br /> ...�- <br /> {If other than wnerl <br /> _ R DEP TMENT.USE ONLY 1( <br /> APPLICATION(ACCEPTED BY --- .---.-.--••- -------------- ) --.._. QATE .,::! <br /> 1-­17... <br /> BUILDING PERMIT ISSUED -- -� '"'------- ---------------------------------DATA: . <br /> --------- <br /> ADDITIONAL COMMENTS ------ ------- ----------------- <br /> ------- ---------------------------------------------µ---- -- -----------------. - - - .."..--------- <br /> --- ---- ---•r NN\ r1 a. <br /> 's' - ---------- .......-.'- . ................................. <br /> ---- -- <br /> Final Inspection by. .•---------- .. .-----••--------•--•------------ Date ....7�. .-�.. 1.•-----• <br /> ER 13 2h 1-68 Aev. 5M SAN JOAQUIN L CAL HEALTH DISTRICT 8/7h 3M <br />