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FOR OFFICE USE: <br /> w_ APPLICATION ICOR -SANITAYION PERMIT _ <br /> ......................................... ...... <br /> •- m <br /> f j (Complete in Triplicate) <br /> .....................Permit No. ` <br /> .........ti_._.... <br /> D <br /> r ' this Pon"It Expires # Year Fret" Date lssaed x ate <br /> 1 �' f-4, .. „_ <br />( Application is hereby made to the San Joaquin'Local.Health District for a permit to construct and N Install the work herein <br /> described. This application is made in compliancsrwith County Ordinance No. 549 and existing Rules and Regulations. <br />' JOB ADDRESS/LOCATIO <br /> 1•- .. .` S TRACT ........................... : <br /> Owner's Name ._---__.... I <br /> •• -•.... Phone <br /> 04 <br /> Address --• ... ... S�( . ....:City <br /> i <br /> Contractor's Name .--•---._-- - --€License iil� :,j Phone �� -- <br /> � . <br /> Installation will serve: s Residence VApartment House[] Commercial Q'Traller Court } <br /> Motel ❑Other-•-- :t. - ._.... <br /> `s <br /> Number of living uni#s:...l <br /> Number-of <br /> umber --'_ Garbage Grinder .......... Lot Size �... .�� <br /> c� 1 <br /> Water Supply: Public System and names t _ - <br /> pP Y� <br /> {, .._.Pri ate Q. <br /> Character of sail to a depth of 3#eot: Sand-Q S€it0 Clay {]. Peat 0 4fSandy Loom{ Clay Loam Q <br /> . 4 <br /> # Hardpan Q Adobe Fill Material...__.......yep;type ' <br /> ............a.. ............ <br /> (Plot plan, showing size of"lot;`E itio -of'system in relation to wells,,buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: t t w a V-r'`* d ' <br /> (No septic tank or seepage pit permitted'if.pu� sewerris'available within 200 feet,] Ar <br /> i . <br /> y <br /> PACKAGE TREATMENT .[ SEPTIC TANK <br /> � <br /> �ze..__....!�' .'-�-i=:�"•. ................ Liquid Depth :--��--1�•�---=--- <br /> Caaci � Y ,. '" <br /> p ty y��= - 'yf # <br /> __..._ -- _ ___-- •--: Material....�d.7iif�4�._ No. Compartments <br /> Distance to nee est: ell �?s ° Line� 'foundat€on Pro L <br /> LEACHING LINE t _ ____.__. Length of each fine'.../.....1 .-."...-•--- Total Length .- <br /> L l No. of Lines ............. ' <br /> fi d - ..� <br /> 'D" Box Type Filter Material &°:_...:Depth Filter Material _ <br /> 1)istaMe to nearest: Well -_---- •--------------- Foundation" , ...� �e�. Property Line.......t - •...................•-- <br /> SEEPAGE PIT # t-__--- <br /> ] Depth ._.._. -------• Diameter ---------- •--_. Number .Eti <br /> . ............. Rock t=illed Yea ❑ No 04.'Water Table Depth .. �Rock Size f <br /> ....•---.,.. <br /> Distance to-nearest: Well .... ...................... ... .Foundation ......... .......... Prop. Line <br /> � ...................... <br /> REPAIR/ADDITION IPrev. Sanitation g Permit . . 'Date""—• } <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) � .0 S Q <br /> t' <br /> u i <br /> ------------•-•---------- ----- 3 4K Z�� c�t.�•• ..... .. <br /> .................................................................. <br /> --------------- ----' e�_!. �s.-�-3,1 I <br /> -------- _ ---------- - --—-----•------ ........... <br /> (Drd'w existing and required <br /> addition on reverse'side] <br /> I hereby certify that i nave prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State laws, and Mules a.nd�Regulations of the San Joaquin Lo'cal Health:District. Hoose owner or licen- <br /> sed agents signature certifies the following: , <br /> "I certify that in the performance of the work fir which this permit is Issued I shall not employ ae <br /> � p , p y y person In such manner � <br /> as to become subject to Workman's Compensarw"-dws of-Califdinia:' '�- <br /> Signed __..... -•--•-- - k <br /> --•---r•---�--- - ------------••-----------..._.---- ---- Owner <br /> BY ` -----------• ---- Title _....--._...`�--, "_ <br /> r <br /> ....................... <br /> (If of than wnerl - x <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> -- ---------------- ----------------------------.. DATE <br /> BUILDING PERMIT ISSUED ----------------------------- -• . .--••-----•-• ........••--- ------- <br /> DATE ` <br /> � <br /> ---•---ADDITlONAL COMMENTS ------------------- --•-------------(.�_..j ..........`_:....-----•-•�-----•-------..............................--------------•---............. <br /> - <br /> ----- <br /> Final Inspection by: - - <br /> • •--- ---- ---- Date f <br /> EH 13 2h 1-68 Rev. 5mSAN JOAQUIN LOC r. HEALTH DISTRICT 8/7h 3M l <br /> • <br />