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FOR OFFICE USE: - <br /> APPLICATION FOR SANITATION PERMIT <br /> -------------- --------- ---------- <br /> - (Complete in Triplicate) Permit No. ____73____--/QC_________. <br /> --------------------------------------------------r---- - 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 /> JOB ADDRESS/LOCATION .rd`S/ 5_0M"&_9---i_4&ATL__---Ole--------------------------------CENSUS TRACT <br /> --=-----------------------9.1ffZF�----------------------------- -------------- <br /> Owner's Name ------------------------Phone ---A.�_V__�!l�.�_-.__-- <br /> ------------- <br /> Address ----- -- ----------------------- A-�---------------------------------------------------------------------------------------------------- Ci OANT6714 A <br /> Contractor's Name --------._A4,__rtti-G_-Pii----------------------------a,.-------------License # 267—CM--- Phone <br /> Installation will serve: Residence %Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number <br /> ---------------------------------------•yNumber of living units:-----I----- Number of bedrooms _______Garbage Grinder ------------ Lot Size _____IAC ._______________________ <br /> Water Supply: Public System and name ---------------------------------•----------------------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Sift❑ Clay ❑ Peat❑ Sandy Loam X 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 side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> � 1� <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size_ ------------ Liquid Depth ---__44;_ _________.,..-. <br /> p Y Yp Material--- ------------------ No. Co_tip&tmehts --------R---------- <br /> Distance-to nearest: Well ------------------------------------Foundation ---/b------------- Prop. Line ---!_''t,1...........' <br /> LEACHING LONE k [ No. of Lines -----�-------------- Length of each line__/G'-_f_____.._.__ Total Length ......... %A <br /> f <br /> 'D' Box .-_- Type Fitter Material hl`' _Xa_ADepth Filter Material ----/g--------------------_............ <br /> tDistance.to nearest. Well ______________________ Foundation .../C--------------- Property Line ___tvi__-_______---.-_- t f� <br /> SEEPAGE PIT [ ] Depth _____ Diameter ______________ Number ____________________________ Rock Filled Yes ❑ No C3 ,V- <br /> Water Table Depth ------------------------------------------------Rock Size --------------.---------- 3 <br /> i Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------------ _ --.__-- <br /> REPAIR/ADDJTION(Prev. Sanitation Permit# ____________________________________________ Date _____-____-_______________________} <br /> Septic Tank (Specify Requirements)"- -------------------------------------------------------------------------- ------------ ------------------------{ <br /> Disposal Field_�(Specify Requirements) --------------- - -----------------------------------------------------------------------------------------------Y <br /> -. _ _ . <br /> ---------------- -------E ---------- ---------------- ----------- -------------- ------------------------ --------------------------------------------- ------- --- ---- <br /> (Draw existing <br /> -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 D <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <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 /> as to become subject to Workman's Compensation laws of California." <br /> Signed ---------------------------------------------------- Owner <br /> BY --------------- -------------------------------------------------------------------------------------- Title ...... ------------------------------------------------f--------------- <br /> tI.-..,:(lf.other than owned -FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- <br /> ------`--------------------------------------------------------------- DATE ----fir _`-7-J---------------- <br /> BUILDING PERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE -------------I-------------- ---------- <br /> ADDITIONAL COMMENTS --------------------------------------------------------------------------` Y = "� <br /> -------------------------------------------------------------------------------------------_ ----------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------:-------------------- --------------------------------------------------------------------------------------------------------------------------------- ----- <br /> Final Inspection by: -------------- - «�`+� --------------- ------------------------ --------------------------------Date l <br /> -' --�------------��-- -- - -� - <br /> SAN JOAQUIN LOCAL HEALTH'DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br /> ,/ <br />