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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> " ! (complete In Triplicate$ Permit..No. 7 - ...7 <br /> This ferrnit Expires 1 Year From Date Issued data Issued . .................. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constrtict,and Install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESSAOCATION ! f ._. /_d��,F /_f ................ -.-CENSUS TRACT <br /> Owner's Name ..,/ e ................:....:................Phone .................................... <br /> Address .. • � ... . :.-�' .....---...:City ................. <br /> Contractor's Name ---- - .... ......License ....... . .....Phone................ <br /> ... ............................ <br /> i ff <br /> installation will serve: Residence VApartment House C1 Commercial oTraller Court 0" <br /> Motel ❑Other <br /> y.....--• ........ ..... <br /> t ,� r' <br /> of <br /> Number of living units:_-. ..... Nu-nqber of bedrooms _.�,�-...Garbo a Grinderz <br /> .. Lot Size 0�.���......... <br /> Water Supply: pubfic System and-name _... .�:- <br /> r-. .� :.l:....:............... <br /> .._.....private ❑ <br /> Character of soli to a depth of 3 feet: Sand L Silt❑ Gay ❑ Peat❑ Sandy Loam {].,Clay Loam ❑ <br /> Hardpan® Adobe Fill Material .......... If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells,?buildings, etc, must be placed on reverse sld <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if publ�c sewer is available-within'200 feet,) <br /> PACKAGE TREATMENT I ] SEPTIC TANK f ] Size_..........: ................................ Liquid Depth ------------ ............. <br /> Capacity No. Compartments .............. <br /> P ry ...-•--------------- 'fYPe ----------••--=---.. Material-------------- _....... <br /> Distance to nearest: Well ....................................Foundation _--------_-------- Prop. Line ...................... <br /> LEACHING LINE ] No. of Lines ........................ Length of each line.........._.:............... Total Length ............................. <br /> 'D' Box ......_. ... Type Filter Material ....................Depth Filter Material^ <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ `,1 <br /> SEEPAGE PIT -.,.E 3 Depth .................... Diameter ......... ------ Number .-------------_----.------ Rock Filled Yes 0 No ❑ <br /> Water Table Depth <br /> ................................................Rock Size ...............-................ <br /> Distance to nearest: Well ........................................foundation .................... Prop. Line ...................... <br /> REPAIR ADDITION(Prev. Sanitation Permit# _..........-_•---•................•......... Date ----------------- ........... �. <br /> Septic Tank (Specify Requirements) - ----------------- �......... • ..... _._. ... <br /> Disposal F' (Specif R uireme is u <br /> t <br /> Y q 1. �� <br /> Ww -. /.I ,l-. ....... <br /> •--_.. <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 Regulation oof`thi Seii!o`pquEn loiol'HeiIW,'Slslrlit.Hoilte owner or Iicen <br /> sed agent's signature certifies'the following: F. <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner <br /> as to become subject to rkman's Compensat�' n laws of California." <br /> Signed caner <br /> , <br /> � . <br /> S W 7#ie <br /> y` /r. <br /> Y --....- ---- • --•-•. ............. i -----•------•---:. <br /> (if other owne <br /> EPARTMENT 'LIST: ONLY <br /> APPLICATION ACCEPTED BY ------- - ...... DATE ...-_ . ... <br /> BUILDINGPERMIT ISSUED ------ , _..-- -•... ..................... ........... ....................••--•--• --------------DATE ................................. ---••--- <br /> <, AQDITIONAf_ COMM T �__. - ._....._.. <br /> 6----------- •- ------- - -••------------------------------------•-- ..................--•................ ----•-------------- ................ <br /> • ---- --- •----- . -- ------- --------..................•----------------.._..-- ........................ <br /> Final inspection by: - ----- a =•.:......' .._. ....Dat e1- ^ cam-J` <br /> 13 2L -{f3 , <br /> 0 UIN LOCAL HEALTH DISTRICT �`. �8/74 3M <br />