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FOR OFFICE USE: <br /> j APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No: 77 <br /> --------=------------------------------------------ <br /> This Permit Expires i Year From Date Issued Date issued -e3- <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> k <br /> `7 <br /> JOB ADDRESS/LOCATION ._203-a-1___;_.I-_��__._-_.�?_t�L_���1�___________________"__.._-_-CENSUS TRACT ___J�.__•'_ <br /> �� ------ <br /> Owner's Name _..--++��-Cm..-�--- �------L/ � i�-----------------•-•--------- ----------------- ------------ ------Phone ------------------------------------ <br /> Address ----------�j 3.24----------- ---------- ----------• City ------JE-&C._� -------------- <br /> Contractor's Name 6FN -----AV --L.R_-__- _ -- ---.License # ------------------------- Phone ------------------------------ <br /> Pn. ao�C RI-S <br /> Installation will serve: eos}dence C&ApC artment House�❑ Commercial ❑Trailer Court iQ <br /> / Motel []Other -------------------------------------------- <br /> Number of living units:..... Number of bedr oms 3----i__Garbage Grinde/�ls Lot Size Wcp4e4c­i�F_........... <br /> Water Supply: Public System and name ----------------------- ------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt•Qf'�'Clay .❑ Peat Sandy Loam -❑ - Clay Loam PR—' <br /> Hardpan ❑ Adbbe '❑ Fill Material _ _ -C!:__ If yes, type ---------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seep pit permitted if public sewer is available within 200 feet,) /� Li <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[/ Size_7r5X_ /_X._: _________. Liquid Depth --/-�______________ p, <br /> Capacity/1(1100"_._ Type �i_?EF�t_S Material_CVAJrXTNo.f Compartments _____� .......... <br /> istance to nearest: Well - - ----- Foundation __fQ_^ ------- Prop. Line ---- _____________ <br /> t r� <br /> LEACHING LINE No. of Lines --- -------------- Length of each line--- --------------- Total Length /------- <br /> .� . <br /> 'D' Box .,��_ Type Filter Material 8��1:_Depth Filter Materia! f _-_____._______i_______________ <br /> �`t ='-- .� s -�- <br /> Distance to nearest: Well ___ _ ____ Foundation ._f__,_____._______._ Property Line _-_____,.. <br /> SEEPAGE PIT Depth -- Diameter ________________ Number ------------#__________--____ Rock Filled Yes b No <br /> Water Table Depth ------------------------------------------------Rock Size-------------------------------- <br /> Distance to nearest`1Nell`�--------------------------------------Foundation=-------------�.---- Prop+�Lme -------------------•-- <br /> I <br /> Se tic Tank (Specify-Requirements)�ation Permit# --------------------------------------- - ----Date ------�-\{---------------'�-='-) <br /> REPAIR/ADDITION(Pre.v_San.i.• I F��, � +.. y t <br /> ------------------------------ <br /> ---__ <br /> t- 1. Jr+ <br /> p p f � I,,n, t i -3 kj :,i <br /> Disposal Field {Specify Requirements) -------------- - ----------------------�------!----------------------------- <br /> _-- <br /> ----------- i''! ---------------------------------------------- ----------------------------------------- i r <br /> - <br /> - <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify thati I have prepared this application and that the work will be done in accordaan nce with SJoaquin <br /> County Ordinances, sState}Laws, and Rules and Regulations of tl�e San Joaquin Local Health Disinct. Home owner or licen- <br /> sed agents signafiure c�tifies"the following:----_ .- ,.._- _ . . __.. ._- =-._1 _ _ _•._•._ `. <br /> "I certify in th a ce of the work for which this permit is issued, I shall not employ'any persor4n such manner <br /> as to come sub' t t I or an's Compensation laws of California." 3 <br /> i <br /> Signe - --- lr f . I <br /> - --------- -- - -- - -----------------------___ Owner .. <br /> B - ------------------------ "®"Title - !, <br /> y --------------------- - -------- ' -- - - - ---- --------------------------- <br /> (If <br /> other than owner) ' a i ` I <br /> # FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY : : 7�-- - - <br /> BUILDING PERMIT ISSUED_ --------------- ----------------- � <br /> - ---------------------------------------------------------DATE <br /> ADDITIONALCOMMENTS ------- ----------------------------------- --------------------------------------------------------------- <br /> ------------------------------------- - -------- ----------- =� __-- - _- . = <br /> �` t ,--,-- - ----------------------------------------------- ----------------" <br /> Final ipspect.ion- - - - ----------- ----- ---- r ._,--------------___-------Date <br /> _:--sem <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT i <br /> E. H. 9 1-'68 Rev. 5M <br />