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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 1jr_,7i' Permit No: -7Y_��3�.-, <br /> (Complete in Triplicate) <br /> -� - -- �/_--�------- Date Issued <br /> L-j--------------------------------- This Permit Expires 1 Year from 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/LOCATION -----------.-CENSUS TRACT .......................... <br /> Owner's Name <br /> �_ /� G�1�,<C.CG /C/ e <G-£.�- �- ---- Phone ----- '�= ................. <br /> Address -,F 4y -� -�-7 ------------------------------------------. City _ l Ce j --------------- <br /> Contractor's Name ----__ - --- G}-__--------License # 5 /�„ Phone <br /> Installation will serve: Residence [] Apartment House-[] Commerciatxrailer Court ',❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:____________ Number of bedrooms _.----------Garbage Grinder _.---------- Lot Size ---9. _-_______________ <br /> Water Supply: Public System and name -----------------------------------•-------------------------------•------------------------------------------Privatex <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -[] Clay Loam <br /> Hardpan ❑ Adober 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: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> r <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size________________________________________________ Liquid Depth _- __________-__ <br /> i� Capacity -------------------- Type -------------------- Material---------------------- No. Compartments -----------------:.._. <br /> Distance to nearest: Well ------------------------------------Foundation --_------------------- Prop. Line -------------:__------ <br /> � y <br /> LEACHING LINE [ ] No. of Lines ___/-_-- ________-__ Length of each line_______7.5---_._____ Total Length ,___7-.7:..._.._.__ <br /> s Type Filter Material Depth Filter Material ____ _d�x__l�__P__f___.---_-- <br /> 'D' Box -- ' <br /> .:; <br /> Distance to nearest: Well -__ _______ Foundation ___/10-------------- Property Line __��............. <br /> 107 <br /> SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 01 <br /> Water Table Depth --------------- ----------------------Rock Size ------------------------ <br /> X S fir - -------------------Foundation -------------- ---- Prop. Line ---------------- F <br /> Distance to nearest: Well _____________________ .__.-_ � <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------- Date ____._____--__-- ................ F <br /> Septic Tank (Specify Requirements) ---------•------- ----------------------------- ---------- --- <br /> Disposal Field (Specify R quirements) -- / _____ �____ • ____/l /jl, -_--.--_-%/? • ___________________ <br /> ------7 ----- it f---------Z-5-' ------—­L---------------- --------------------------------------•--•-- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Sart 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: ) <br /> "I certify that ' the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to beco e s ject Workman's Co pensavon laws of California." <br /> Signed ------------------ Owner <br /> ,. <br /> BY Title <br /> (If other an ed <br /> •� OR PARTM ENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- - .-,..--_-- ----------------------- DATE __ -�s1 <br /> - ---- ---------------------------------------------- -- --------------------- <br /> BUILDING <br /> - - - - - <br /> -- -- --- --- ----- <br /> BUILDING PERMIT ISSUED . -------- _____________DATE ------------------------------------------- <br /> ADDITIONAL <br /> _____-__.___._____ _-ADDITIONAL COMMENTS -- ----- - ----------------------------------------- --------- -------- -------------- ----- --------------- -------------------- -----• <br /> --------- --------------------------------------- - -- ----- ----- ------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------- ------ - ----- ------ - ------------------- -------------------------------------------------------------------------------- - --- <br /> -- ----------------- -------------------- - ------ ---- -- --------------------------------------------------------------------------------------- <br /> Final Inspection b - Date <br /> S JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 ev. 5M <br />