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' APPLICATION FM SANITATION PERMIT <br /> ...... Permit No. �� :f <br /> (Comply M Tdpucalel_ .. .... . <br /> .............................................. s 2'4. <br /> . ' Date Issued .�:��." <br /> ................................................... ! This Permit Expires 1 Year from Deft WOW <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work heroin <br /> described. Thier application is made in compliance with County Ordinance No. 544 and existing Rules and Regulotlonst <br /> JOB ADDRESSAOCATION . ............. ....., ! ' 'fit....... �-c�'� .�...........-CEN5US TRACT .......................... <br /> Owner's Name .........---•_.... .45& S' -70....................................... - <br /> ................Phone . <br /> . <br /> Address .. .. .t:..�1.5'.Cj'1.. ...............{... City .... D ,e-------------------------------------- <br /> M b .�. phone --__---------------- --- <br /> Contractor's Name ...... 2_..�,m44x...�� .... ....1�.....�... .._..License� --. <br /> i� <br /> Installation will serve: Residence❑Apartment House 10 Commercial❑Traller Court ❑ <br /> Motel❑Other............................................ <br /> Number of li in n~ . N er roans ...� Garbage Grinder ...l........ Lot Size .....6!. .C41--t!-...•.............. <br /> Water Supply Pu a id name ...... ....... ..»....................._ ---------------------------------------------Private(� <br /> Character of s W Silt❑ Clay ❑ Peat❑ Sandy Loom(3 Clay loam[3 <br /> rdpan❑ Adobe fl Fill Mat 1*f............If yes,type............... ............ <br /> 1PIo Ian, showing size off , 14 on of system in rotation to wells, buildings, etc. must be placed on reverse skis.) <br /> N STALLATIONs: septic or seepage pit permitted if public sewer is available within 200 feet,) <br /> PA GE tJR1Er4ie1r1Ei lfi EPT Size. ....�.J.. .................. Liquid Depth ..... ..�:v.. C� <br /> Co G?C... Type., .. f�. -� No. Compartments .....:2..._......... ._. <br /> Distance rest: Well .......... ..s� n ........Foundation J.0......•• Prop. Line .....:�............ oo <br /> ................ <br /> •LING LINE [ J talc. of Lines .....'tl............... Length of each Ilne..��..�X..�.,... Total Length .......z p <br /> �• x .. ..:-.... Type Filter Material .OL.-4.0!4.Depth f=ilter Material <br /> Distance to nearest: Well d_._ ..... Foundation �1,a Property....T. Pro Line .... ................... <br /> SE G IT Depth . Diameter .I............ Number ...................•........ Rock Filled Yes ❑ No ❑ <br /> Water Treble Depth .....Rook Size <br /> Distance to nearest: Well .......................................Foundattion .................... Prop. line ...................... C <br /> RE / iTION(Prov. Sanitation Permit# ............. _-----------------------_-- Date ..................................) p <br /> SoiTank (Specify Requirements) ........................................... .................. .. ..... ............................... <br /> Di al Field (Specify Requirements) ....................................... .... <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 wIi be done in acemdance with San ,Ioagvin <br /><< County Ordinances, State Laws, and Rules and Regulations of the 'San Joaquin Local Heald District. Hence owner Or Neee- <br /> sod agents signature certifies the following; <br /> "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such mann <br /> as to become subject to Workman's Compensation laws of California." <br /> 4�_ <br /> Sign -•--- <br /> ........ Owner /� vt�-' <br /> BY :. <br /> f of r than.owner( . <br /> FOIL DEPARTMENT SE ONLY <br /> APPLICATION ACCEPTED BY ...... . ............................._............ DATE ------ <br /> BUILDINGPERMIT ISSUED ........................................................... ...-..........................................DATE .......--------------------------------------- <br /> ADDITIONALCOMMENTS ........................................................ ...,-......_....:-. ................................. -------.....____...................._ <br /> _.. ... . . .......... / .__...'... .............. ....----._....---...................---••-•--....... <br /> . <br /> .............. - --•........... ......... ,/�,. . .. ..... ......-•--... ... <br /> Final Inspection by: ..................... . -- ... ................. .......................... :..... .Date . . -` _.. <br /> EH 13 24 1-613 Rev, 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />