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FOR OFFICE USE: <br /> --.................................................... APPLICATION FOR SANITATION PERMITPermit No. Mn.&�I <br /> _.........�....... . <br /> lComplete In Triplicate! <br /> .. <br /> ..........-•-•-- r{- �... --•--•---• <br /> _.�_ <br /> This Permit Expires 1 Year from Date Itsue.d 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 ADDRESS/LOC ION. .....6. 66..._-_... ,..- CS........--•....................................CENSUS TRACT _...._--_ ................. <br /> Owner's Name ._._ ._.L���.�_ �.........--- !A111 V.ROS...................................... ----.-._.....Phone .. ...f. ..._... <br /> Address .........s!_`_._..._..._...._•---- ---•--:City <br /> Contractor's Name -------gACz G.!_(e.................... •-------•-•................:.•----..License # .G. !$----- Phone <br /> Installation will serve: Residence N Apartment House fl Commercial OT'raller Court 0 <br /> Motel ❑Other................................. . <br /> pp <br /> Number of living units:_-•_ _1 Number of-bedrooms .......Garbage Grinder ._........ Lot Slze _..•-..►.7CF ............... <br /> r f4y - __�_ _- <br /> Water Supply: Public System and name ...::..........•-----sc.c_.....__-, _tee-'°�:,...... ._..._--___..I........--__-____________•_•._Private Q <br /> ;_.�. <br /> Character of soil to a depth of 3 feet: Sandj Silt[]4' Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan[] AA,►dobe o fill.*6terlol ............. - ............... <br /> , 'l#'yes,type = _ _ <br /> (Plot plan, showing size of lot, location of system in relation towe Is bpiIf g ,-etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage:pit permitted If public sewer Is available within 200-feet,l <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] # size.......... <br /> .:......---••-- "` - ----- 'L':qulc!-Depth........................... <br /> " Capacity ------------------•- TYPQ�-----`-------------. Material..------= ... .............--•-----•---- No. Compartments .... <br /> . i <br /> Distance.to nearest: Well :__--{..................$.. F....:.Foundation .................. Prop. Line ..................... <br /> LEACHING LINE ( ] No. of Lines ....................`__ _ Length of each'`line._____- ._..__.._.__.•------ Total Length ............................. <br /> D' Box f ,*_.._... T mFilter Material i ...Depth Filter'7Mciterjal <br /> t <br /> Distance to nearest. Well I_.•-. --. � ! r � r <br /> f � Pi'�operty Line__._. ..:.. .. Foundation i...................:...� _ .. <br /> SEEPAGE PIT [ ( Depth ... ---------------- Diameter ________________ Number ---I:..___.................. Rock Filled Yes �] No Q <br /> Water Table Depth ... ............. --------------------------Rock Slze�Distance to to nearest: Well ............:............................foundation ..... Prop. Line <br /> REPAIR/ADDITION(Prey. Sanitation Permit# __..._... _....................... ....... Date ....:........_..............______l <br /> Septic Tank iSpecify.Requirements) -..---•--• ..-• =----•----••••..... .. ......................................................_.............................. <br /> r� <br /> Disposal Field (Specify Requirements) C7®---` ..... ....... ---- +�C ...�!.l!'. ._'....................•---- <br /> 7_1 <br /> • �' 's <br /> ---------------- --------•-••--------- <br /> -•------;------------ ------------ ................................. ------------••-•--•--- .... -• • --• <br /> _ 3 _(Draw existing and required addition on reverie side) <br /> I hereby certify that I have prepared.this appl6'6n 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 licen- <br /> sed agents signature certifies the following: f <br /> "I certify that in the performance of the work for which,this,permlt is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Co ensation laws California." <br /> Signed _ # a= Owner <br /> B <br /> 4 <br /> y -.._.. ------- -----•• ------------­----------:�Jitle ............. <br /> (If other than owner} <br /> FOk C4PAJ(TMENT USE ONLY <br /> APPLICATION ACCEPTED BY _-_----` - - ------ DATE I4 -- ---•-----------: <br /> BUILDING PERMIT ISSUED }. . ----------------- <br /> _5_ <br /> ___-- -- 1'-U---r-r--n- - 7 ... D/ATE�----d----i ----------------------------- <br /> .4 <br /> •----- <br /> 4 "ADDITIONAL COMMENTS oa: e�P <br /> ------------------------------------------------------------ <br /> ---...--•-------- --• --•----•-----------•--•--- ------•- -----=--•- ----•------•-••-------•------------ ------------------- _--•----•----:,7:__­---•--------...-----.-.. -•-----------••• -••----- <br /> -------------------•--- --------•--- ,. < <br /> --:_...-----------•.._..-"............. .----•---------------------._. .. <br /> Final Inspection by: ----- `---.:_.`_.::. 9---...---• ---�....-':":. s..,rr_:=, _ _._Date <br /> 13 2L -68 ltev. SAN JOAQUIN LOCAL HEALTH DISTRICT '8/7h 3M <br />