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FOR OFFICE US ' <br /> I <br /> t"", ev APPLICAT1011 POR SANITATION PERMIT <br /> ------------------------- ------------------- II Permit No.72,.-1-4-3_ <br /> (Complete in Triplicate) <br /> ---------- --= ----- ------- -- <br /> r� � € Date Issued <br /> ------------------------------------------ This Permit Expires 1 Year From Date Issued <br /> it <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: <br /> JOB ADDRESS/LOCATION _ .�e -.ter .- CENSUS TRACT <br /> Owner's Name l'f�C a' 1 F Phone ? <br /> Address t �dcity �. <br /> ---------- <br /> one Name ______ - t- '� .__-- �- r��`----- --------License #"t -- r''` `. - Phone k--:Z ------ <br /> Installation will serve: Residence�kApartment House�❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑ Other -------I-------------- -------- ---- ---- <br /> r <br /> Number of living units:_+Z------ Number of be oommss L (______Garbage Grinder`_ Lot Size _-_,�� <br /> i Water Supply: Public System and name ---- C-x_ iy---------.------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silo❑ 1 Clay ❑ Peat ❑ Sandy Loam -❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe! 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 perm€ cl if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK' 15' SE e___________________ __________________-_ -- Liquid Depth -------------------- G <br /> Capacity ---------- -- i --- Type ------- --------- Material---------- ----------- No. Compartments -------- ----•-----•-- <br /> Distance to nearest: Well ---------- _--Foundation --------------------- Prop. Line ---------------.-.---- <br /> t <br /> LEACHING LINE No. of Lines ----/_______________ Length of each line_-_____ISW_-/------ Total Length _---_,> __________.. <br /> Type "i r� <br /> D' Box ___�_-_ Material __ �-L',____Depth Filter Material __-��_______________________.--.------ <br /> ./ ------------ <br /> ------- <br /> Distance to nearest. Well ed--�- __:_ Foundation ____-� � _ Property Line <br /> PIT Depth '.° Diameter _ -�__r r_. Number _-_____.-_._______---- Rock Filled Yes No �Q <br /> Water Table Depth --------�'- ---Rock Size ----�-- ----------------- <br /> a <br /> Distance to nearest: Well �_____ Foundation ----- -5 -------- Prop. Line _____________ <br /> € <br /> REPAIR/ADDITION(Prev. Sanitation .Permit# -------­------------ ---------------------- Date --------.-------------------------1 <br /> I Septic Tank (Specify Requirements) -- ---- -------------- ----------- -------------------- ------- ----------------------- <br /> ' � -- ------ — J " <br /> Disposdl Field (Specify RegaJrements) __ �� -....-----��---- ------------------------ <br /> 4T <br /> --- --- ------- <br /> ya "t. 'lx�r�r ------------------------------------------------------- <br /> ----- ------ ------- <br /> ------------------------------------ ------------------- ------ - ------------------------ - --------------------------- ------------------------ <br /> {Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that tWw'ork will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or licen- <br /> sed agents signature certifies the following: E <br /> "1 certify that in the performance of the worts for which this permit is issued, I shalt not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------------------- { _ Owner -� <br /> BY ---------- /t_t � <br /> Title - G(If other than owner}-- <br /> FOR DEPARTMENT USE ONLY <br /> i <br /> ! APPLICATION ACCEPTED BY _._ - �_^ ----------------------------------------- DATE _-_-- <br /> BUILDING PERMIT ISSUED ------ C - -----------7 � -- - DATE ------- --------------------------------=-. <br /> -- ----�- --- - - ------=-------------- <br /> ADDITIONAL COMMENTS ----- C ° ------------ Ei a ------------- <br /> -----------F -----------------------------------------------------------------€!-----------------------------------------------------------------------------------------------------'- <br /> ----------------------------------------- ---------------- <br /> -------------------I- ------------------------------------------------------------------------------------------------ . <br /> --------------- <br /> ------ ---- - - ------ ----- -- <br /> FinalFinal <br /> Inspection by: -------------------- ---------------------- Date Wil: = 7 ---- <br /> 1 <br /> SAN JOAQUIN (LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />