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FOR OFFICE USE. <br /> APPLICATION FO-It -SANITATION PERMIT <br /> ....................... .4 <br /> (Campllete in Triplicate) Permit. No. ..................... <br /> 73 <br />.................. ...... .................... This Permit Expires 1 Year From Date Issued Date Issued ............ <br /> Application is hereby made to the San Joaquin Local Health District for a permit 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 /> t <br /> JOB ADDRESS/LOCAT16N ....... C 1�761 1, ....cee6-2-71<...... .......CENSUS TRACT --- <br /> Owner's Name .....A _ <br /> .A `.......::!�- 1711....................... ....................r........... ....... .........Phone..5,23-05. <br /> r- <br /> Address ......... s�y 5-14 R.4,4, !G C.) <br /> ............... ......... city ............................•--........ <br /> Contractor's Name ... ..........................................License #�V.z5-6_X.21. Phone <br /> Installation will serve: Residence CUApartment House C-] Comrnerciol :F]Trollor Court 0 <br /> Motel Fj Other .................. ......................... <br /> Number of..l ivi ng,units:../.-._.�-__Number_of.bedroorns,...,?. ...Garbage,Grinder...,V.......Lot-Size ............. <br /> � "J"'U", 11 -— <br /> Water Sup.ply:.Pvblic System and no .. .............. <br /> me 7_f5 Ale ......ale�,ee<..........k:f .. ...........Private ❑ <br /> Character of soil-Ip a-depth.-of 3 feet: Son&)U . Silt 0 Clay 0 Peat 0 Sandy Loom 0 Clay Loom C] <br /> - <br /> Hardpan-E]—Adobe-(3-Fill-M6terial-7r= If-yes;type ------------ <br /> (Plot plan, showing size of I lot, location of system in relation to wells, buildings, etc. must be placed' on ;reverse side.) <br /> NEW INSTALLATION: iNoI! i <br /> septic tanklor seep e pit permitted If public sewer is available within 200 feetfeet,}-.9te-1 I <br /> PACKAGE,TREATMENT SEPTICTANK Size.4!5�- <br /> Liquid Depth .. .............. <br /> _4J9 .1 <br /> $Tj.5;� No. Compartmbri <br /> Type atericil_P ts ......... <br /> V <br /> Wei n .,A15---- _ - .....5............. <br /> istance tFo nearest. .... .. ......... .......Foundation.0 1 ........... Prop Line ........ <br /> No. of Lines A14rc7X ne/O.Y..4 ... Total Length. ...... <br /> LEACHING LINE [,o0j'i aegth of tach I! _C7... <br /> Box Type Filter Material ',,*X4;.Z�Depth Filter, Material ................. ...... <br /> Prop" <br /> Distance to nearest. Well ...... t.W_�... Foundation ........................ Lne .........­­........ <br /> SEEPAGE PIT Depth ............. ------ -Rock Filled Diameter ................ Number ............................. Yes 0 No 0 <br /> Water Table Depth ...................................•• ..........Rock Size.-- ----------------4-------- <br /> Distance.to neaeest: Well ........................................Foundation .................... Prop. Line ............. ......... <br /> REPAIR/ADDITION'iFVev. Sanitation Permit# ............................................ Date ............................... <br /> Se, I ! -------SEPTT( <br /> tic T�nk (Specify Re .............. ................... ........... ............ <br /> Disposal`Field. '(._Qtp-Iecify­3'R <br /> _iFe—ments) ------------------------------------- -U-- --------- - <br /> ...... -.-. ..-.. .­-­---- <br /> �J - ----- - ----6.7a...... ---------------------------I .. --. - --- -- I-- ------------- ------- <br /> ........... ----------------------------------------•--•---------------------•------ ..._.....__......._---...._r-.. ...---'-.._:-. -------------- <br /> (Drd w 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 <br /> I accordance with.Son Joaquin <br /> County Ordinances, State,laws, and Rules and Regulations6f the Son Joaquin Locai-Health-District.-Hoge owner or licen. <br /> sed agents signature certifies the following: <br /> certify that in the performance of the work far which this permit is issued,­1 shall not employ any,person in such manner <br /> as to become stib-1 f-p Workman' ompensation laws of California." <br /> jec <br /> . ..... ........................... Owner <br /> Signed <br /> ............................... ................. ---------------------­--------- <br /> By ..... ---------­­............... ............. <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY. If <br /> :km n... <br /> 10 am <br /> ................ ......... ....... <br /> APPLICATION ACCEPTED .............. DATE <br /> BUILDINGPERMIT V�c?�'r.0 .................. .....................................................................................DATE ...._.....---••-..._....... ....._..._.._.. <br /> S <br /> ADDITIONAL COMMENTS .. ..... .... . .....................................^. ............. ............... ........ .......­..................................................... <br /> M <br /> ...................!.............. .. .... .. ............... ........ . ............I-—...... ................................................ .............. <br /> ................ ...................... .......... ........................ .......... ... ................ ................................................. ....................... <br /> ---------------- ------------------ --- .... ..... ...........I.......................... <br /> Inspection <br /> L . .... ....... . . ...... . . <br /> ...... ....... <br /> Final Inspection -------- -- -- ----- .... . ... . ............................. Dote ... ...... .... <br />