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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION >?I:RMlT 7yy� <br /> Permit No. ... - <br /> ( (} - (Co'mplete in Triplicate) ......•........ <br /> .............. <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 ap lication is dd in compliance with County Ordinance No. 549 and existing Rules•-and"Regulations: <br /> J08 ADDR S LO TION /�?f`� r��`�'� <br /> �...---....--• +.. <br /> � �.....CENSUS TRACT <br /> Owner's Name ... . .. ....................... -.... <br /> ...... Ph ne -----•-•....................... <br /> Address ......... <br /> .... .....�,�. .....� ...-- -- �--• -• ..�..�., ..... city <br /> Contractor's a ..... -".- '� � -.License <br /> t <br /> Installation will 7servel. Residence partment House❑ Commercial ❑Traller Court 0 <br /> Motel ❑Other ......................: x <br /> Number of living units:........... Number of bedroom's _-3.....Garbage Grinder _ Lot Size ............... <br /> Water Supply:.Public System and name -•- ' <br /> ----_.._. ,❑ .y.......Private ❑ <br /> Character of soil to a depth of 3 feet: San ❑ ❑ Clay ❑.. ❑ SandY Loam Clay Silt Peat Loam ❑ <br /> �►� Hardpan-0_-:..Adobe_ _ -•F li.Material .1/va.. If yes, type ....................:. .. <br /> Plot —.�.�... . . �- --- •_� <br /> { plan, showing size of lot, location of system in relation to wells, buildings,.etc, must be placed on reverse side.j <br /> . NEW INSTALLATION:_ (No septic tank or seepage pit permitted If public sewer is available within 200 feet j <br /> PACKAGE TREATMENT [ = SEPTIC TANK Size... . v �r <br /> r <br /> ��•`�r�`-- •--•-------------------- liquid Depth _���,........ <br /> Capacity / Type No. Compartments <br /> � 44 / ; .................... <br /> D' tante to nearest: Well .......... Foundation .. .............--_- Prop. Line . .. <br /> / / <br /> / O <br /> JLEACH WG�ilNE�[: No.,�of Lines ,, ,�.. .Lengthxof each.,line._ � �D <br /> I , Tour.le .1 <br /> D' BoxType Filter Material Depth Filter Mater ,I <br /> . - , <br /> Distant to n�rest: Well . /�---�_.. Foundation �-. ---------. Property_ Line -�.._..�__. <br /> SEEPAGE PIT [ Depth p Diameter ... Number ---------c� --•-- Rock. Filled- Yes <br /> I' Water Table Depth .......... ,.f ............ .......Rock Size .1/ _ .X.. . . <br /> r Distance to nearest: Well <br /> c es ,! ...................Foundation / ....... Prop-Lin e...... .......... <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ................................... Date ---•--............................ <br /> + r <br /> Septic:Tank (Specify Requirements) <br /> j_..,. <br /> Disposal Field (Specify Requirements) <br /> ............. <br /> a _ — i <br /> TM <br /> •-"-"--•................•-----••--.._...._.....---•---_.I...............- <br /> .........---' <br /> -------------------.----------------.-----------------....-._.. -"--•_.......................................... <br /> ' (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.San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Healih, 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 .. . _.. . ..::.�..�.... <br /> W <br /> ---- Owner <br /> B ••--- ... •. <br /> ------•- ..-•----•-----.....--•-------....•fit e .......��....�Td`�'�........�`.n�.._ �,.��.� <br /> (If other than owner) <br /> OR DEPART ENT USE ONLY R <br /> APPLICATIOWACCEPTED BY- ' <br /> .... ..... .. ...............•-_........... <br /> BUILDING PERMIT ISSUED ...... :.......... ..... .... .- ...... <br /> DATE _ . . � l � -- :-- <br /> ..... .. ----------- -=-- DATE ........ ... :... <br /> ADDITIONAL COMMENTS ... 6­ <br /> ell fj. /-,e. .___ #V�40�GlJr�... <br /> --.....---•................................. ­..Z.......... <br /> ..._ .... <br /> . -. ". <br /> ........................... 'ate <br /> Final Inspection b �, ........ ......_. <br /> p y: .. �� j� .. s '.....----- ......... ..'Date : ��r� <br /> *` SAN JOAQUIN LOCAL; HEALTH DISTRICT <br /> H.1 24,1--68 z <br /> E. H. 1•'68 itev.. SM ��7172 3 X <br />