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1,9R OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------- - --------------------------------- Permit No. <br /> (Complete in Tripl�ica!&' <br /> ----------------------------------- --------------------- <br /> Date Issued <br /> ------------------- <br /> This Permit Expires I Year From Ddte 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 aril existjAg Rules and Regulations. <br /> JOB ADDRESS/LOC' VON ---/776-9;------(S-------5-UT-1-1-Ft-- -------------io-----------------CENSUS TRACT --- ----- - ------- <br /> ---- <br /> Owner's aMe VE' r47=7-4-W4 1__S,Ors(---+,-flo-LL ---------Phone -------- ------- <br /> Address A�59S F----- ------�5TREE77___ ._ city -----OAKDP_L�-E�------------ <br /> - -------1177 ------I------- <br /> Contractor's Name ----- -------C NTE R-------------- it----License # --'Phone 07--l-j- <br /> -]Trailer Court <br /> Installatibn will serve: Residence Er)Oartment House,E] Commercial:E_ /0 <br /> Motel E]Other --------------- --------- <br /> ----------- <br /> Number of living units:_.___ ---- Number of bedrooms __3----__Garbage Grincler/��5--�Ldt Size --------- <br /> jc-7- <br /> Water Supply: Public System and name ----------------------------------------------- ------------------:--------.1---------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'; t� I?y EPeat_ .,-a---S- 2-dy-,L,oa-m -E - <br /> Clay Loam- <br /> Hardpan doe0 Fill Mdterial ----- If yei, type --------------------------- <br /> (Plot plan, showing size of lot, location <br /> wells,of system in relation to ells, buildings, etc.1must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or pit permitted if Public sewerds available within 200 feet,) <br /> PACKAGEIC TANK.- �_t, <br /> TREATMENT Size__5__XJ_0__X---6-----------_-L- Liquid Depth,�-I_16A ........­___ <br /> SEPTIC 1 11- 1 - <br /> 1 0 - aferialcpfj�ka � , —-------- <br /> Capacity -1.570j42___ TypeAWAV M ' EN.O. Compartments <br /> it ;j C <br /> 'stance to nearest: Well _ � ----- Prop. Line LI-5 ---------- <br /> --- <br /> ------------ .r-------Founcidtion ---- ------ <br /> 19----- <br /> LEACHING LINE No. of Lines/__- f1_7-- ------- Le\ngth of eac in .---- -- -------------- Total Length ------------ <br /> 'D' Box V�!S Type Filter Materitil _R_0_C_X_DepthA0ter Material _____1/9--_--`_-__`-. --?------------- <br /> Distance to nearest: Well ------/P---- ounclation ------- Property Line ----_S.7---------- <br /> R k Filled Yes 0 Na C] <br /> Diameter Number ------------ Rock i . <br /> SEEPAGE PIT [el DeptFT 17--- ------- <br /> Waier Table Depth --- ----------------Rock Siz� --- 11--77--- <br /> -------------------- <br /> ,Distance to nearest. Well --------Id <br /> ______----------F6-067&i2n 0 _Prop..Line ----------- <br /> REPAIR/ADDITION(Pret. Sanitation Permit# _.!____________________f_______ .__._ _____ Date .__._____-------------- ------ <br /> SepticTank (Specify Requirements) --------------I--------------------- ------ ------I-------------------- --------------------(------------------------------------------------ <br /> Disposal Field (Specify-Requirements}-r-- ------------ --------- ------ -----I------------_--------' ----------- ---------------------------------- <br /> I ---------------------------------------------------I-------------------- ----------•--•-------------------- <br /> ----------------------------------j-------------------- --------------------------------------- <br /> ------------------------------------ -------- ---- ----------- <br /> ---- --- ----------------------------------- <br /> I (Draw 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 accordance with Son Joaquin <br /> County Ordinances, Laws; and- and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signaturettifies the following: <br /> "I certify ItatIn the performance of tge-work for which this(permitis-issued,_1.shall,not.employ..any person In such manner <br /> as to be<OWsubjec rkm o I�n�aLto!%laws of California." <br /> (;;ho <br /> . . .. . ........... <br /> Signed ------ ------M ------------. Owner <br /> By --------------------------------71-------------------- --- ----- ---------------------- Title ----------------------------- -- --------------------------------------- <br /> (if other than owner) <br /> I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ------------------------------------------- DATE ------- --- -------------- <br /> ----- --1- <br /> BUILDING PERMIT ISSUED - -------------------------------------------------------------- ---- -------- --------------DATE ------------------------------------------- <br /> 0 <br /> ADDi,T-IONAL-COMMENTS . ---------- --------m-------------------------- <br /> --------------------- ------------------------------------ - <br /> -------------------------------------- ----- ------ <br /> ------------ <br /> ------------------------ - -------- -a- e2,- -------------------------- ----------------- <br /> _7:7.,�'tj� ------ ------------ --------- <br /> --------------- <br /> ---------------------------------------Date ---- <br /> -ti by. <br /> Final In <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev, 5M <br />