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t FOR OFFICE USE: <br /> APPLICATION 'FOR SANITATION PERMIT <br /> -------------------------------------- <br /> (Complete in Triplicate) Permit No. .76:__G_(_ <br /> I <br /> ---------------------------------------------------------- This r Permit Expires ] Year From Date Issued Date Issued <br /> Application is hereby made to the'San Joaquin Local Health District foraermit to construct and <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules tand Regulations rein <br /> >>t <br /> JOB ADDRESS/LOCATION '_--- 1_ _- ---- J_I�l/V/VJ/ --------- ' --------- --CENSUS TRACT ------------------•------- <br /> Owner's Name ----- -- /r/ rFF-------A - �.�/�7V/ <br /> - --- - -------- ----------------------------------- -Phone ------------------------------- <br /> Address ------------- <br /> -------------•--------...--- <br /> Address �__ <br /> ------ -- S --fJ'G.�C_Tu_A-l' ---•if-�_-L1�--------------------------- Citw .S�T� -• ------------------------------- - -- <br /> Contractor's Name ---------- 17 F---------------------- ------------------ -----------=--------License # ----- ------------- Phone <br /> Installation will serve: Re dente [�A�tjnent House�0 Commercial:❑Trailer Court ;❑ <br /> #X OtheM <br /> ---------------------------------- <br /> - <br /> Number of living units:---- ._ Number of bedrooms ------------Garbage Grinder ------------ Lot Size _-- __x__ /_�� <br /> ----------------------- <br /> Water Supply: Public System and name -------Private ❑ <br />` Character.of soil to a de th.of 3 feet: Sand' Cla <br /> { p Q Silt Q' y -ElPeat ElSandy Loam ❑ Clay Loam:❑ <br /> Hardpan,&'��Adobe D' Fill Material ------ If yes, type ____________________________ <br /> (Plot plan, showing +size of lot„locationof�stem in-re' lation,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,) W <br /> L b <br /> PACKAGE TREATMENT S IC TANK J} '^ �`_�,G Liquid Depth ____`SI.-_____ ... . ' <br /> I Size !/ <br /> Capacity �- <br /> R Y -E'-- Type -------------------- Matenal__lr�►/G___-- No. Compartments N ' <br /> IX 1 ] p --- <br /> Distance to nearest:`Well ----/_b6______-- -__-_--_Foundation ------ Prop.Prop. Line <br /> LEACHING LINE No. of LinesLen g <br /> --------------- Length of each line .- ----.-__--- Total Length <br /> 'D' Box _ Type Filter Material _- ly�lDepth Filter Material --__ --- <br /> ------------------ <br /> Distance <br /> ____- __Distance to nearest: Weil ________________________ Foundation ------------------------ Property Line- -____-____._.__1_Y.:.. <br /> SEEPAGE PIT f [ ] Depth -------------------- Diameter f <br /> ________________ Number _____._________.___________ Rock Filled Yes ❑ No i❑ <br /> ' F F <br /> Water Table Depth ------------------------------------------------Rock Size -------------------- <br /> Distance to nearest: Well ____________________ -------- _---------Foundation -------------------- Prop. Line .------------- --- <br /> • '., <br /> REPAIR/ADDITION(Prev.. Sanitation Permit# ____________________________________________ Date ---------------------------------- <br /> Septic <br /> --_-_-_-_____________ _ -._--___Septic Tank (Specify'Requirements) -------------------------------------------------------- <br /> Disposal Field•_(Specify,__Requirements} _----______-_ __ <br /> ------------------------------- -------------------- ----- - -------- ----------------------------------------- <br /> ------------------------ --- --- ` <br /> 4 a '(Draw existing and required addition on reverse side) -- <br /> --------------------- <br /> 1 hereby cern that I have Y I <br /> Y fy prepared this application and.that the work will be done in accordance with San Joaquin <br /> County Ordinances, State'Luws, and Rules and Regulations of the San Joaquin local Health District. Nome 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' Compensation laws of California." <br /> Signed -X- � ----------------------------------------------------- Owner <br /> By --------------- ----------------------------- ----------------------------------------------------- Title ----------------- <br /> (If other than owner) i. <br /> # FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -___________ __________ •_ <br /> s G�L� .;.� ------ -. DATE ----�- t - <br /> BUILDING PERMIT ISSUED F ------- ---DATE.-------- <br /> -------------- ----- <br /> NAL COMMENTS --------------.;_-,_-:- _ . <br /> ----------------------------------- <br /> --------------------------------- .. . . : . <br /> ---------------------------------------------------------------- ------------- <br /> ------- <br /> -------------------------------------------------- <br /> SAN <br /> ---------------------- ----- --------- } <br /> Final Inspection by- ------- ----- - - -------_---Date ---- _- 0 . <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br /> 01 T 4�1­ <br />