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FOR OFFICE USE: � <br /> APPLICAYION- FOR SANITATION PERMIT77 <br /> - --�� �. c. Permit No. - Z-6-6-U... <br /> ---------- . <br /> (Complete=in Triplicotp)_ _ <br /> ----- Z O I7- <br /> This Permit Expires 1 Year From bate Issued <br /> ---- <br /> Date Issued _��-------------- <br /> ------- -- <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,inco fiance with County Ordinance No. 549 and existing Rules and Regulations: -i <br /> JOB ADDRESS/LOCATTIIOON� .----- <br /> CENSUS TRACT -- ------- <br /> Owner's Name !tf -•----` -`-� r- Phone <br /> ...... <br /> ...� ------ city -----, p <br /> Add�ess ------------ - -- --- -- / ' <br /> Contractor's Name ------------------License #s l-- Phone <br /> I ` <br /> Instaflation will serve: Residence OjApartment House-E] Commercial ❑Trailer Court :E3Motel F-1OtherN---------- ------------ ---- ------ / <br /> l g I __.�-_Garba Grinder _ff------ Lot Size -.---_!_ _at_e-------�---- <br /> Number of living units:.--. --_.__ Number of bedrooms ge G Private <br /> Water Supply: Public System and name ------------------------------------ =--- ------- -------...----------- ---------_-------- <br /> Chorp cter of soil to a depth of 3 feet Sand❑ Silt❑ Clay ❑ Peat`❑ Sandy Loam ❑ Clay Loam "❑ <br /> Hardpan ❑ Adobe:&-` Fill Material \-------- If yes,type --__----------------------- <br /> {Plotjplan, showing size of lot, location of system in relation to w,eI1s,_buildings, .etc_, n)Xt be. .placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if-public sewer is available within 200 feet,) J <br /> PACKAGE TREATMENT [ ] SEPTIC TANK; Size---------�_/CC-- `1-- -/--_,N Liquid.rl7epth --- ...------- �I <br /> L <br /> Capacity -- Type -- - Y <br /> -------- <br /> �_-------Foundation --- a-�___-- Pro Line --- ...,:..f <br /> Distance to nearest: Well --_-______--� - - _-i -- Total Len p ---_-_ ---;�------- <br /> Distance <br /> Length of each lin Length �� <br /> LEACHING LINE No. of Lines --------- r!`''•� "V <br /> D' Box ----.1------ Type Filter Material -------- Depth' Filter Material _-._----1_-7--- ----------• ---- <br /> Distance to nearest: Well _- f ____mFoundation_-_r Line -- .._i_._.._.. <br /> 'a V <br /> i ► I <br /> SEEPAGE PIT [ ] Depth -_ ____---- Diameter ----- _----_ Number -.--_---------------------- Rock Filed Yes 0N <br /> le I❑ <br /> WaterTabDepth -----------------------------------------------Rock Size -------------------------------- <br /> x , I O� <br />' Distance to nearest: Well ----------------------------------------Foundation --- .----_-- -.-- Prop. Line ----_---_--[_:_.__.- <br /> REPAIR/ADDITION(Pre,, Sanitation Permit# ._--l-- - -- Date --_-----1 -- -------- ----) � <br /> - I <br /> . <br /> Septic Tank (Specify'Requirements) --------------- ; ------ --- -- -; ----- <br /> Disposal Field (S pecify Requirements) ----- * �. ', - <br /> F - - ------------------------------------- <br /> i- I-- +� <br /> -------- --- ----------- -- -- --------------------------- -------- _= <br /> tY I (Draw existing and teeluired addition on reverse s ole) <br /> rf' <br /> I hereby certify th tll have prepared this application aiVd,tg tithe work will be ,done in accordance with San Joaquin <br /> County Ordinances, §taf'e Laws,ii�nd Rules and Regulations off the San Joaquin Local Health District. Home owner or icen- <br /> sedagents signature the'following: t�r <br /> "I certify that in the performance of the work for which this permit is issue ued,1 shall not employ any person in such manner <br /> as 1 ' 's Compensation laws of California."j <br /> b I - � <br /> Signed ecome subject'to Workman's-Compensation man # � ------ Owner y <br /> -- 1- <br /> _ ------------- <br /> TitleP-a -------------- <br /> TBY@ ? <br /> " �if�f other than owner) <br /> F PARTMENT USE ONLY <br /> APPLICATION" ACCEPTED BY - ------------------------------------------ ` - DATE, _.. �- - <br /> BUILDING PERMIT ISSUED -------- !� -------DATE------- ------ ----------------=-t----•--- <br /> ADDI,T[ONAL COMMENTS _ - - - -- - = -------------------------------- --- -----------------------------------•_.------------------------------------------ <br /> ----------------------------- <br /> - •-------• •-•---- ------ <br /> r <br /> ----------------------------------------------------------------------------------------- <br /> t ;�F' �e -- ---- --------------------•----------f------- <br /> -- ----• •--------------------- ------ <br /> E- -------------------------- --- - - -- -- ------ ---------------------------------------------------------------------------------------------------------------------------------`= <br /> FinalInspection by. --- -- --- -- - -- - - �`]--------------------------------------------------------- - - -- ------- <br /> -------.Date f=.� --------- -------- <br /> %AN JOAQUIN LOCAL HEALTH DISTRICT <br /> I <br /> E. H. 9 1-'68 Rev. 5M i <br />