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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> - (Complete4n Triplicate) Permit No: <br /> ----------=-- - 72 <br /> Date Issued - ...... <br /> ------------------ --_: __----------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Jo quin Local Health District:fora 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 . �( �J� � I �-r 'W�1I--- - ---.CENSUS -TRACT. a� <br /> Owner's Name ----------- `--------- -4QM__19_----------- V4 q�,, -Phone -------'--------------------------- <br /> Address _ _ _ ---------BROWA--------V_ — City --------Rtpo.14-------- ----------------------------------- <br /> I <br /> Contractor's Name -------- W11M.-.---------------------------------------------------------License # ------- :---- ------ Phone ---------- -------------- <br /> Installation'will serve: Residence WKpartment House❑ Commercial ❑Trails Cou t0, <br /> MotelP-Other _r_--- --____ <br /> Number of living units:________ Number of 'bedrooms __Z!Garbage Grinder - �_._.Lot Size __/i�_�_ _ _(�-------- <br /> - - r <br /> F -t -- 1: ----------- rCla- 'La m <br /> Water Supply: Public System and name .- _-- - -- --------- - ---------------- <br /> Ri <br /> R Character of soil to a depth of 3 feet Sand T-1 L Silk.❑ .Clay ❑ Peat❑ Sandy Loam 0-` y Private❑ <br /> YP <br /> Hardpan ❑ Adobe'❑ i F,~fI Material _yw-­lf-yes.ta __ _.- _ <br /> '------- <br /> (Plot plan, showing size of lot, location of system -irn relation to wells, buildings, .etc. must beyplaced on reverse side.) <br /> -NEW INSTALLATION: (No septic tank or seepa it permitted if public sewer is available wit 'n 200 feet,) 1wl <br />` PACKAGE TREATMENT [ ] S'EPyTICTANK.i Size----------------- Liq •id bepth' _____- ------------------- <br /> Capacity ; -------------- Type == -- Material------------------- No. C, partments ------ -- 9►+ <br /> Distance to nearest: Well ------- ----------------------f-.---_Foundatiorr------------------ - Pr6VAine------------------.--- <br /> I fly, V <br /> l LEACHING LINE [ ] No. -of•Lines�.,,--=N-`____`--"-Le gth-of each'. lino_-'-_--___ -_--:_i--'_- Tata Lengh' --------------•------------ <br /> i <br /> 'D' Box ------------ Type Filter Mat rial ---•________________Depth Filter Material -------------------------------....--.-•.--- <br /> I �...; ua <br /> Distance to neariAt�iWell __________ _____________ Foundation .__._____-__._________ P operty Line ________-_. ----__-:___. <br /> SEEPAGE PIT [ Depth -------- --- Number ------ --------------------- ❑ No ❑ <br /> ------- <br /> Diameter _ _ _ -- � ck Filled: Yes <br /> 'L. " 4 C J <br /> Water Table Depth -------==---------- ------------ -------=--_-Rock Size -------- --------- -------------F' # <br /> Distance to nearest: Well _ ,___ /________________;..Foundation„_.:'__,,,: Prop' '-L' _____-_-________.___-. <br /> - - -_ <br /> REPAIR/ -(Prev. Sanitation Permit x# ___.____.----='- ------- Date ------------------------ <br /> ADDITION '- --.---} <br /> Septic Tank (Specify Requirements) ----------------- -------------------------------------------------��---- i� �------'---------------------------- <br /> Disposal Field (Specify Requirements) ,/ L:___-CIVCREfi ----- r - •---=----------- <br /> D t _0_x <br /> LWES <br /> ---- 1_ cf , <br /> ---------- <br /> e <br /> J _ 0 --------------- <br /> ------ <br /> ----------------------------------- ---------- -- - <br /> (Draw existing and required addition on reverse side) _ } <br />' 1 hereby certify that I have.p`repared this application and that the work will bel done`ini accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Jonquin`,Local Health, District. Home owner or licen-. <br /> sed agents signature certifies the following: cs 0 I' i <br /> "I certify t ' the perfo^ q cel of the work for which this permit is issued, 1 -shall not employ any personAn such manner <br /> as to beco subject to W n's Compensation laws of California.” << l <br /> Signed ----- Owner # <br /> 1 <br /> By ---- ---- - '�-- --- --------------------------------------------- 't, - Title - `` - <br /> f <br /> (If other than owner) I <br /> ! FOR DEPARTMENT USE ONLY ;i <br /> �-t- f <br /> ACCEPTED BY --------- [ ` ------------ -----------------------------------. DATE ---- `�`; " ---------- <br /> APPLICATION ► <br /> € BUILDING PERMIT ISSUED ------------------ ----- ------ i DATE - A <br /> IADDITIONAL COMMENTS _--_ `------ --------i -------------------------------- --------- - ------ - -------------------------- -- ---- --------- - -----------------------•------------------------ ;------,-----------Y--Final Inspection bjcL `' `•-` ' -- ` ``; ---- <br /> ------- Date _.. --,. _......_..--_.SAN JOAQUIN...LOCAL-HEAL-TH. DISTR.ICT,,,. ..,. <br /> E. H. 9 1-'68 Rev. 5M `' ' <br />