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FOR O FICE USE: <br /> APPLICATION ICOR SANITATION _ - <br /> - tCornplets in Triplicate) Permit No, <br /> ......... .....................I......--- _ ..:5....� .... <br /> This Penetf#Expires Z Year From Dah Issued Date Issued ��..:.�.7 <br /> Apkcation is hereby made to the San Joaquin Local-Health District for a per to construct and install the work herein <br /> d scribed. This application is made in compliance Vit County �din nce No. 549 and existing Rules and Regulations: <br /> / w1 <br /> JOB ADDRESS/LOCA <br /> TI d S <br /> CENSUS TRACT ..._ <br /> Owner's Name ..._..... <br /> TPR <br /> _ - <br /> - - - -�.�..........-- �ho"e ��.?-:^/�-��......--- <br /> Address .._................r y <br /> _....... ........... ............city <br /> Contractor's Name .............. License #.2- Phone . - <br /> _e....o - ......................... <br /> _ _ ------•--..._ <br /> Installatiosl w€II`serve: _-- ---- Residence -- ---artment House Commercial <br /> �P ❑ Trailer iCourt <br /> Motel ❑Other-•--------• ......................-- <br /> Number of #;'ring un <br /> Number Number of bedrooms r <br /> ----••---:..Garbage Grinder _-........._ Size ��....�.1.?� . <br /> -•---- -•- ..._...----•-•- <br /> Water Supply: Public System and name .. <br /> ...; .: ........................ -- ,..-- - -...........Private [� <br /> Character of soil to a depth of 3 feet: Sand[j S-ilt[ $ Gay Peat 0 Sandy Loam p. Clay Loam <br /> Hardpan Df AdobeFili Materia! ............ If yes, <br /> tyre-- <br /> _ <br /> Mot pian showing size of lot, Ivcation of system in`relati0n7to wells, buildings, stc must be placed on reverse etas,) 44 <br /> NEW INSTALLATION: � I <br /> (No optic tank or.seepage pit permitted,if,pubfi sewer is available within 200 feet,) <br /> PACKAGE TREATMENT-f-]- SEPTIC-TANIC'� ]e;< JAV Size*� <br /> Liquid Depth ........................... <br /> Capacity - r..... TY Materiaeri}o-ekZele. No. Compartments ..2e:.............. <br /> Distance to nearest: Well' Foundation . <br /> r <br /> .-•-•••--.......•-- Prop. Line...................... (V <br /> LEACHING LINE ` it`-�^-�I-�•----�-�-'-�---- �.r• ---�--•-�•. <br /> [ l No. of Lines ---------------------- Length of each line-.-... .------..• -•-•I.... Total Length ..........-•- - % <br /> .%... <br /> '©' Boe � r <br /> _... Type Filter Material ...Depth .Filter Material <br /> .. ..............••-__........._._ <br /> 1_ Foundation _ Property Line .' <br /> SEEPAGE PIT I � Depth to to. nearest, Well .....---. -•---........ <br /> SEE P •---.. Diameter .--_---_-•-- Number ...................�....... Rock Filled Yes Q No (D <br /> WaterTable Depth .._Rocki Size <br /> Distance to nearest: Well ,_....-°...._ %J.:.............Foundation <br /> ................ <br /> REPAIR/AI1Dfirld(Prr�ev:-.Sanitgtion Permit -- Date } Prop. Line .................... <br /> A f �y - <br /> Septic Tank (Specify Requirerrmen#sl <br /> ...----.............--- v.I....... <br /> ----- ---• - ----- <br /> Disposal Field (Specify Requiremeritsl <br /> i . . •. -- <br /> ...__: f <br /> - <br /> ,� .. ....... <br /> zjre <br /> •- •--- ...... ; <br /> - <br /> -- ••- ----- -------- <br /> #Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this applicatio an nd that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws. and Rules and Regulations of the San Joaquin Local Health:District. Home owner or Ifcen- <br /> sed agent; signature certifies the following: <br /> "1 certify thrtt in the performance of the work for'whlch this permit Is issued, 1 shall not employ any person In such.manner <br /> as .to become subject to Workman'sCom Compensation laws of j <br /> Signed ---•-`-------...._ p California."- t <br /> Owner <br /> By •------ Jitle <br /> b <br /> (if of r ban owner) -------- ----------------�-•-•---• r <br /> FOR DEP R ENT USE ONLY <br /> APPLICATION ACCEPTED BY _._ .. <br /> ..... .... ................. .DATE ....... . <br /> BUILDING PERMIT ISSUED __•-------------- ;--------------- <br /> .........................__._...__._....__.--_-•-----•-_ --.DATE ................................... 4 <br /> ADDITIONAL COMMENTS ....--- ... = -.._.. :` _ --...._. <br /> ---------------•--------- -----------...----` --------------•------------------------------------------.-------------- -•---...-----.........-----------•. .................... <br /> --------------------- ••.. <br /> r,•Y <br /> Final Inspection by: --- -.... _ G,/ .................-----------'- --•--�_ - <br /> ............... _.._...._.._._..•------------...__.--_Date -.�J <br /> ,EH 13 2h 1-68 5M SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 8/7h 3M <br />