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FOR OFFICE USE.. <br /> ------------------------------------------------------------ APPLICATION40R. SANITATION*PERMIT "6 <br /> ------- (Complete in Triplicate) it No: :76,7 <br /> - - <br /> ----------------------)U <br /> --------------- This Permit Expires I Year From Date issued Date Issued <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 ADDRESSAOCATION -_7 _ 4X_-A4_ (---------- CENSUS TRACT -------------------------- <br /> Owner's Name ----------------------------------- Phone <br /> :��----------------- <br /> Address ---------�2 __�------ --------- ity <br /> V, ) �- - � '12--e-----_-, C --- ---------------------------------------------------------- <br /> Contractor's Name ------- M'4 4-t- -4 <br /> W------ ------License # lf4r `ice Phone ------------------------------ <br /> Installation will serve. Residence [5 Apartment HouseE] Commercial '[:]Trailer Court :F-1 <br /> Motel [] Other <br /> Number of living units:------- . Number of bedrooms --, -_a <br /> ---Garbage Grinder ------------ Lot Size ---------------------------------------- <br /> I <br /> Water Supply: Public System and name ---------------------------- <br /> I -----------------------------------------------------------------------------------Private <br /> Character of soil to a depth of,3 feet. Sand E] Silt C] Clay E] Peat El Sandy Loom -ETII� Clay,Loom <br /> Hardpan E] Adobe-E] Fill Material-------------- If yes, type ---------------------------- <br /> (Plot plan, showing size of 16t, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No se <br /> ,ptic tank or seepage pit permitted if public sewer is available within 200 feet,). <br /> PACKAGE TREATMENT SEPTIC <br /> EPTIC TATANK'[ Size------------------------------------ ------------ Liquid Depth -------------------------- <br /> Capacity -------------------- Type -------------------- Material---------------------- -No. Compartments ------------------ <br /> I Distance to nearest- Well -------------------------- - <br /> ------..Foundation ---------------------- Prop. Line ---------------------- <br /> LEACHING <br /> LINE ,No. of Lines ------------------------ Length of each line---------------------------- Total Length ------- ---------------- <br /> D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------- --------- ------------- <br /> Distance' —tcnearest: Well ------------------------ Foundation -----------=----------- Property Line ------------------------ <br /> SEEPAGE PIT, Depth -------- ----------- Diameter ---------------- Numbe- ----------------.------------Rock- Filled Yes El No .C] <br /> Water-Table,.Depth ------------------------------------------------Rock Size -------:­------I------------------ <br /> Distarice to nearest: Well ------------------------------------•--.Foundation -------------------- Prop. Line ----------­---------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------•------------------------------------ Date -------------------------- <br /> Septic Tank (Specify-Requirements) ---------------------------------------------------------------------------------------------------------------- <br /> Disposal Field (Spe� ify Requirements} d Ar <br /> ----- --- ..V-n-P- ------- 141_�e <br /> -- --------------------------------------------------------- <br /> - 01-1------------- <br /> ------ ------------------- ---------------- ----------------------------------------- -------------------------------------- I--------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side)--- <br /> I hereby certify that I have prepared this application and that the work will he done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and ReguActions of the San 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 <br /> . . . permit_is.issuedj shall not employ any person in such manner <br /> as to beiome subject to Workman's Compensation laws of California." <br /> Signed __1 ------ Owner <br /> :� <br /> ------------------- ------ <br /> By -------- -------- <br /> rr <br /> (If other than owner) <br /> FOR DEPA-RTMENT USE. ONLY-m"Lr <br /> APPLICATION ACCEPTED 'Ioz­� <br /> V DATE __,I -- --- ------ <br /> p <br /> BUILDING PERMIT ISSUED --------------------- __DATE <br /> ADDITION AL COMMENTS <br /> -------------------------------------------------- --------------------------------------------------------------------------------------- <br /> --------------------------------------------------- <br /> --- -----------------------I-------- ---------------------------------------------------- ------------ <br /> - - ---- --- -------- -- -----------------------------------------*------------- <br /> -------------- <br /> Fi ------------------------------r---------------------------------------------------- <br /> nal Inspection by. -------------------------------------------------------------------------Date ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br />