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FOR OFFICE USE: i APPLICATION FOR SANITATION PERMIT <br /> ii S� f <br /> --.... ...- -•-.-- ----..----•----.. .Permit No. ..7---------------- <br /> lCompletein Triplicate) <br /> ......................................................... <br /> .._:... Thi's Permit Expires 1 Year from Date Issued bate Issued l�"a 3:1-.. <br /> .... . ... .. L <br /> Application is hereby made to the San Joaquin loco[ Health District for a permit to construct and install the work herein <br /> described. This application Is maddee/In compliance with County Ordinance No. 549 and existing Rules.and Regulations, <br /> r JOB ADDRESS/LOCATION .__ ......{.� '��'Q 6;-W-J:C.L1�........................CENSUS TRACT .......................... <br /> l r Qq <br /> Owner's Name ... a .....91....1r!tl 4, . 1b! ..-..............r.....................................Phone ...... �.L�Q./• <br /> Address ."7' .�:_.L .i l '�Q• I.��. . �Y <br /> Contractor's Name . ,d.._��.`,�•..Q d_.,�e.�L_.License # Zj-7/77... Phone*KK, er ..:. .--. <br /> Installation will serve: ResidenceXAportment House 0 Commercial{:)Trailer Court 0 <br /> I� Motel ❑Other............................................. <br /> Number of living units:__°__/.... Number of bedrooms .......Garbage Grinder . .__ Lot Size ......-•.................................... <br /> Water Supply: Public System and name `j'..: .....................................Private <br /> Character of soil to a depth of 3 feet. Sa S�It Q Clay .C3 Peat❑ Sandy Loan 0 Clay Loam <br /> Hardpan p Adobe 0 Fill Material If yes,type <br /> --------------- <br /> (Plot plan, showing-size-,.of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEIN INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [:] SEPTIC TANK{ ] Size ... ...................... .••--_--- Liquid Depth .................. <br /> Capacity , -- - _ <br /> ___-•- TYpe Moterial. . �o. Compartments ........ :....�i <br /> Distance to nearest: Well ---•.__.............................Foundation ..-- -------- Prop. Line ..., ...........� <br /> LEACHING LINE [ j No. of Lines . Length of each line............................ Total Length ............................ j <br /> 'D' Box Type Filter Material ....................Depth .Filter Material .............................................. <br /> Distance to rest: Well .._..__...__.._._......_ foundation .......... ............. Property Line ........................V <br /> [ ) Depth .- .......... Diamete�Z - -- Number -----------•-1....../.l. Rock Filled Yea No Qy_ <br /> Water Table Depth ----------- `~ Rock Size .......I � ------ <br /> i <br /> Distance to nearest: Well ...............�`......................Foundation ........ Prop. Line ...4:§.-"...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............. Date ..................................) <br /> Septic Tank (Specify Requirements] ................. <br /> Disposal Field (Specify Requirements) ...................... •---•- -----•-•.........................•---.------ ----......_.................................:--••---.... <br /> i <br /> •----------•:--------•-• ........................................_.---...--••----••----•--•----.....------------------ <br /> ` (Draw existing and required addition on reverse side) <br /> 1 . <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 Laves, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or lieew <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of the work for which this ,permit is Issued, I shall not employ any person in such manner <br /> t as to become subject to Workman's Compensation laws of California." <br /> Signed ............ ...................................................... .............................. Owner <br /> By ... - --:,. Jule ..... k <br /> ( (If other than owner <br /> t f R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED'BY ............. - -•-- = ...................................... DATE ----.---- <br /> j BUILDING PERMIT ISSUED .-------- ---------------..------------- ----------- -------.----------------:--..............DATE ._­....— <br /> ............ <br /> ADDi,T10 AL COMMENTS <br /> ------- ----------- -----------------...-......................--------....... ------------------- ...................... <br /> ................................................ ........•-- ............................................ .................. --------...................................._..- <br /> Final Inspection by: ............•....................................Date .... ..`... '. ..... <br /> EH 13 2h 1-68 Rev.. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT $/7h 3M <br />