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'FOR O'FFICE'USE- <br /> APPLICATION FOR SANITATION PERMIT <br /> .........­........ ............I................. Permit No. <br /> (Complete in Triplicate) <br /> ..........I...... ................................. . <br /> ________________•....•-_-...._.............-_.---. This Permit Expires I Year From Dot*Issued <br /> Application is hereby mode 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 %sting Rules and Regulations: <br /> JOB ADDRESS/LOCATIO19 ..,..CENSUS TRACT .............I............. <br /> _4 ...........................................t.................. . . . Phone .......... .................... <br /> Owner's Name <br /> Addres ....................................... ........ 2 --------- <br /> s ­........ .�p <br /> City <br /> ............. .......................­­----------- <br /> Contractor's Name ---- ---"-- 4/........................License 40 Phone <br /> Installation will serve: OL me <br /> Z t1d erice Apartment House 0 Cogn ' rclal OTraller Co'urt 0 <br /> Motel 171 Other........................................... <br /> Number of living units:--/---_---- Number of bedrooms ....�k---Garbage Grinder .............Lot Size ............... ................ <br /> Water Supply: Public System and name ........................................................--___- _..._................._.......................Private. . <br /> Character of sail-t6w1860th-of 3 feet: Sand Silt 0 CIW0`Peat b !:_Sandy_Loam 0-' Clay loam o <br /> Hardpan 0 Adobe 0 Fill Material ............. If yes,type .............. .... ....... <br /> (Plot plan, showing size of lot, Ic6ti*n of system In relation to wells-, buildings,-.etc. must be placed on reverse side-1 <br /> NEW INSTALLATION-. (No septic tank or seepage pit permitted if public sewer.is"available within.200 feet,) <br /> PACKAGE TREATMENT fA SEPTIC TANK; ................... Liquid Depth . -•-•-..:............ <br /> Capacity --- Type Material---- -- ------ - No. Compartments .............. <br /> Distance to nearest: Well ...............174undation .10........*..... Prop. Line ......... <br /> LEACHING LINE No. of Lines _,12 ............... Length of each line.._712 ....... Total Length ........... <br /> V Box Type Filter Material .. .....Depth Filter Material ....413..................... <br /> Distance to nearest: Well ...... Foundation .......... Property tine ........... <br /> le, <br /> .. ................ <br /> . ....... .7.....P <br /> ........ ... .................. <br /> ......... <br /> ........ Prop. LI ................... <br /> Distil wrest: We I N�.......... ............. . .....Foundation ...... T <br /> REPAIRADDITION(Prev. Sanitation Permit# ............................ ....... te .................................... <br /> SepticTank (Specify Requirements) -----------------------*.................... ............................................................. ..........------------------ <br /> DisposalField fSpecify Requirements) ----------­.................... ..............�­...................................................................;............. <br /> ........... ...............................................................................................................;--------I........................ ..................... <br /> ------------------------------------------------------------------------------ .................... <br /> ------------------- *----------------------------------------------*........................... ........ . <br /> ;Draw existing and required addition on reverse sidej. Z <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin- <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health,District. Home owner or licen• <br /> sed agents signature certifies the following: <br /> "I certify that In the perFormance of the work for which this permit is Issued, I shall not .employ any person In such manner <br /> as to become subject to Workman's Co ation laws of California." <br /> i <br /> . . ...... ................. Owner <br /> ................. <br /> LJ <br /> By 4el Witte --------------------—............................................... <br /> Signed ------ ---- ---- ---- --- --- - <br /> tithe a ��e r <br /> ggR QEPARTMENT UU ONLY <br /> APPLICATION ACCEPTED BY -------4�Vlf `- - --- - -------- ....... ...... ------------- DATE <br /> BUILDING PERMIT ISSUED ------------------•____-. <br /> ----------- ........... --- ----------------------_-_..................-DATE ------- ------------- ......................... <br /> ADDITIONALCOMMENTS ----- .. ..................................-----------------•-----...-. ---------__ •---•------------------- ......... ............ <br /> -------------------------------- ------------------­---d---------------­---m------------1-1--------------- -------------------­---------- --- ...... -- ----------- <br /> .......... ------------ <br /> Y - -------------------------1------------------------­-----1------ --------------------------- <br /> ...............­­­--- --- <br /> final Inspection b . -------•-•-•.....................•........--- ........................Date <br /> EH 13 24 1-68 aev. 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />