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FOR OFFICE USE: <br /> y . . APPLICATION FOR SANITATION PI=RMIT <br /> ................ ----_.-_.......••-••••-=-__. . _ <br /> Permit No <br /> )Complete in Triplicate)- <br /> .......................... ' F <br /> t - <br /> �. <br /> This Permit Expires 1 Year From Date Issued <br /> Date Issued :-— -LC–_7� <br /> Applicationis hereby made to the Son'Joaquin Local Health District for a permit to construct and "install the work' herein <br /> described`This application is made in compliance wit County Ordinance No.'549 and existing Rules and Regulations:. <br /> , <br /> JOB ADDRESS/LOCATION ......-•--/-..7 •--- • ......................................... .. . <br /> CENSUS TRA�C/Y .... . . <br /> Owner's Name ........... /t_ I. ............. Phone'`.7 3_. '_.. <br /> ���,, _. <br /> Address ...--••••----•----....��T.l. ? -^- -._... ..... .... ..... City ' _ <br /> ..... <br /> Contractor's Name _.. •• ........... . l�...:........License# 7D; ..-i ne7_?_? "4 f6D <br /> Installation will serve: Residence.PWA' artment House Commercial <br /> P � ❑Trailer Court, �] <br /> _ Motel C]Other .............. .........•------•_....:........ <br /> Number of living units:... ______._ Number of bedrooms __.._ Garbage Grinder .......... ......... s .l.' ?........... <br /> Water Supply: Public System and name ........... ..... ".--•-- <br /> t <br /> Character of soil to a depth of 3 feet- Sand�. SII#®� !Clay j] Peat❑ Sandy Loam ❑ Clay Loam•❑' .z I <br /> } Hardpan[❑ Adobe Fill Material ..........:. if yea,type <br /> •. ... .... ............ <br /> (Plot plan, showing size of ]aQ ation of system in relation to wells, buildings, efc.�"must be'placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank o)"`' seepage pit permitted if public sewer likavail'cble within 200 feet,) <br /> Coaci CRTANKf ►J a..� Size.--Y2.64 t ............................ Liquid Depth ...........................' PACKAGE TREATMENT P SST.1' ! <br /> . _ `ii GliG......_ Type oterla ...................... No Compartments --- r_ --__--__� <br /> t: Well _ ._ I'lio ..iA„�skFoundation - -/Q...4....... Prop. Line ----, <br /> LEACHING LINE Not oneaes �Length of each 1ine.._ ...,,�-iQ......_-_- Total Length ...,�__Q. <br /> l ......... .... <br /> f 'D'-Box 1�11P pe,Filter',Mateda) s.Gr�.....Depth .Filter Material - ........................................ <br /> _. <br /> L ' E <br /> Distance to nearestzwell KR s�,�..___.. Foundation _-�l�_�f _- Property Line .....L"� ._....:. <br /> SEEPAGE PIT ( ] Depth� ._ ,Dkameter -----------.. ... Number : ..................... . Rock Filled Yes ❑ No HCl) <br /> Water Table`Depth. ---•---- ••----------- .................Rock Size ..................... ----•----- <br /> t <br /> Distance to nearest: WeII' .:Foundation=_! _.- Prop Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit,# .............. .. Date -__.---.__.........._....._..__-�•} D <br /> 1' <br /> -r � <br /> Septic Tank {Specify Requirements) -•••• ����l�t.-w <br /> Disposal Field (Specify_Re uirernentss) r _ —� c�2 ... � �1c/�t� 7 <br /> P /q ..._... ..... ......... <br /> 4 <br /> r <br /> -------- --------------------- --------- :_....---__AlQ --4--Q4gr-1..---- .............--.---- .................. <br /> .:- - ----------------- <br /> ---- .------•-----••-••-..........._.. .........._.................-........... <br /> (Draw existing and equired addition ori reverse side) <br /> i'hereby certify that"'1"have prepared this application and that the work v`rill be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San .Joaquin locat Health:Dlsfkct. Home owner or Men- <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of-the-work-for=which�thispermit-is issuad,11 shall not employ any person in such manner <br />` as to became subject to Workman'Compensation laws of California." <br /> :Signed -------------- <br /> --------- r--- ------ :t--------�............ Owner <br /> BY------ --------- -- -.l_ �. _:1TitI� ............... <br /> # Ia tha weer - �` - ! h <br /> I <br /> FOL DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ .--------------------..--------- ...... DATE .,r/_0G ,;✓ �.._...-.: <br /> ------------ <br /> ADDITIONAL a PERMIT ISSUED : i <br /> DATE ... __...- <br /> ILDIONAL COMMENTS .A jj4o r ._ / s r-�rrirP ,p4.. �!-dlry -----C-0d_ s f -.._... - ------- ----- ----- <br /> F ...-------•._..-••------------ ---•............ .•-- <br /> -------------------------------- -- ----- -•-- - ------------------------------------------------ <br /> ------- -- <br /> final Inspection by- - """�--- ------------- -- --------------------------_Date . <br /> EH 3 .24 1-68 9 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br /> , <br />