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FOR OFFICE USE <br /> APPLICAT16t FOR"SANITATION PERMIT Z2- 7�k <br /> --------- ---------- ----------------------cl�5 <br /> i I (Complete in Triplicate) Permit No: -------------------­ <br /> ----------I------ ------------------ <br /> 7 Date Issued <br /> --- --- -------- This permit'Expires I Year From Date Issued <br /> - <br /> -4 -----------------7--7-1 <br /> —construct -'6' XI the?wUowqrkherein <br /> )W <br /> Application is hereby made to the San Joaquin Local-,Health District for a permit to co 41?4and i <br /> described. T�Iswp Ii is made in compliance with County Ordinanc No 549 and existing Rules and Regulations: <br /> .9ppication <br /> I C I I <br /> avi ;Z& <br /> -------------- ---------------------- ---------- --------CENSUS TRACT -------------- <br /> JOB ADDRESS/LOC 10 -------- ---- - - - ------f, --------- <br /> Owner's Name r. ---------------- ------------Phone----- -------------Phone ------------------------------------ <br /> Address - ---------- -- --- <br /> - - ----------- City <br /> --- - -- -- - - ---------------License%­�O-P---- --------------------- <br /> - -------- <br /> ------------------------ ------ <br /> Contractor's Name i <br /> -- Phone <br /> Installation will serve._ _Residence-; -partent House.-D'Commercial0 Trail6r Court f] <br /> Motel F-1 Other ------------------- ------------------------ <br /> Number of living In.its:._.__I-_._ Number of bedrooms' 2-------Garba-ge Grinde - ----- - Lot Size -------------------------------------------- <br /> ater,supp Pubiesyst6m,and name ------------ <br /> ------------------------------ ------------- ----------------------------------------:-Private <br /> C Silt <br /> Character of <br /> I y EE]—Peat-1] -Sand Loam 1E] Clay Loam-E] <br /> soil to o'depth of 3 feet: Sand' <br /> - [] El a <br /> 01 <br /> Hardpan E] Adobe�E3/, F <br /> Z y ----------------------------- <br /> 36q S7-7-7 ilIa-M­t;rjZV- ------ ifes, Type 4 <br /> (Plot plan, showing size of lot, location of system in relation ic, wells, buildings, 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,) <br /> TREATMENT SEPTIC TANK <br /> ,57--------------------- Liquid ------- <br /> PACKAGE TREAT' Depth -------- <br /> .r Capacity Typ <br /> e./ ateric' 11!!?vo ---- No. Compartments ---2�1------------- <br /> Pr n <br /> S-7 <br /> 11 Distance to nearest: Well Z----------S ___________________Foundation ---- ---- 60. 11 1; <br /> A4.1 ------- <br /> LEACHING LINE No. of Lines ---- ---------r:------ Length of each line- Total Length ------------ <br /> 'r <br /> 'D' Box 1 &-44 --Depth Filter Material Type Filter Ma --------- ---------------------- <br /> r S <br /> 6'46 nearest: We --------------------- Founclatio ------------ -------�f-, Property Line ----------------------- <br /> S PAG' Q ------ Number ---D- <br /> EE E PIT Depth it-S----------- Dicimeter.33--` ------------- --------�3!Zock Filled Yes No CC] <br /> Water-Table)Depth *- --Vl-----------------------------------Rock Siz -- <br /> ---- <br /> -X <br /> Dis<once to nearest: Well ------- <br /> /-----------------------------Foundation Prop. Line -C- ------------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ________-__--___-___.-__--_______-) <br /> SepticTank (Specify Requirements) ------------:---------------------------------------------------------------------- ------------------ ----------I,--------------------------- <br /> Disposal Field (Specify Requirements) ------------------------- ----------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------I--------�"­-w---------------------------------------------------------------------------- ----------------------------------------------------- <br /> ------------------------------- -------- <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 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-signatuie 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 Compensation laws of California." <br /> Signed ----- ---- ----- ---- --- ------- Owner Owner <br /> -- ------------------- <br /> By ---z------------- ------- 'Title ---- <br /> e r�t --o--,w---n-e-r-1----------------------------------------------------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -----------e- ------ ---------- -- ------------------------------------------------------ DATE ­,'777/�-,?7-7-—--------- <br /> BUILDING PERMIT ISSUED -----------------------------------------------------------------I------------------------------ :-------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS --------- ------------------------------------------------------------------------6----------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------0----------------------------------------- ------------------ ----------------------------------------------- ---------------------------------------- <br /> --------------- <br /> Final Inspection-by:��.�--- ,W- .- ----------------------- --- -------------------Date.---i --- -----7----------- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />