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0 <br /> FOR OFFICE USE: �# I- <br /> -APPLICATION FOR SANITATION PERMIT-* Permit No. P"'7 <br /> (Complete in Triplicate) <br /> Date ? <br /> This Permit Expires 1 Year From Date Issued Issued z-. :7�"9_1 <br /> ------- ---- ------- ----------------------I — <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described. Mi-s application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> N -------- ------------ - CENSUS TRACT -------------------------- <br /> JOB ADDRESS/LOG ?.60(/ __ <br /> " I . - " - --- -t-- --- ----- ------:��------------- <br /> Owner's Name ----------------- -------lit------ - - - -------------------------------------- -- Phone ----- _78-------0_?V___3 <br /> Address .-.------------------->101, ----------- -- city ------ ---------------------------------------- <br /> Contractor's Name ------------ ----- -_ --- ------ ---------------------------------------License # --------- -------------- Phone <br /> Installation will serve: Residence Apartment House,[] Commercial []Trailer Court `0 <br /> Motel'n'Other ------------- ----------------------------- <br /> / 1--31 <br /> 1 <br /> Number of living units:_________ Number of bedrooms _71 -&arrb1._q9e Grinder W-0--- Lot Size ---------------------------- <br /> ---------------- <br /> I <br /> Water Supply: Public System and name ------------------`-----=----------------------- - Private E] <br /> Character of soil to a depth of 3 feet: Sand'[:] Silt 0 Clay 0 Peat E] Sandy boamf:) Clay Loom 0 <br /> H a rd-p-a n _. —AdoTeFJ1I'Materi2iI' If yes,N type ---------------------------- <br /> Vr- e <br /> Mot plan, showing size of lot, locc�tion of system in relation to wells, build fhs�, etc. must be placed on reverse side.) <br /> .# 4 1 <br /> NEW INSTALLATION: (No septic tank or s4epdge pit pe�miftecl if public seer is,available within 200 feet,) <br /> PACKAGE TREATMENT f I SEPTIC TANK[ ]"�NaZ Size------5_1X_151_----------------- Liquid Depth -----51-------------- <br /> Capacity"/>06f/Type llgir-T---- Material,_G4.CAKT6_ No. Compartments --- ----------- <br /> - Ar <br /> Distance to nearest. Well ----------- -Foundation ------}Prop. Line ----�-- -------- <br /> LEACHING LINE. No. of Lines -- Length of each line----7-5------- -------- Total LAth --- ----------- -- <br /> I k 1 0"* <br /> 'D' Box .___--._Type Filter,.M6terial goick-----Depth Filter Material \__/_8------------------------------------ <br /> ► <br /> Distance to nlearest: ---------------- Foundation ---1 Q ------__ Property Line ......... <br /> SEEPAGE PIT eater <br /> epth pi'vi-neter �Abe- ------ -----------\ Rack Filled Yes No C] <br /> Number <br /> Table 011� -----------------------------------------------RockR ��I <br /> Distance to nearest: Well -----------r-—--------------Foundation ----- --- Prop. Line ....�5�------------- <br /> ­-� I I �Ij <br /> REPAIR/ADDITION(Prev. Sanitation Permit —----------------- Date ------ --------------------------- <br /> Septic Tank (Specify Requirements) ------- ---- -------------------I--------------------------- --------- ----------------------------1----------------------------- <br /> Disposal/Field (Specify Requirements) ------------- -------- -------------------------i-------------------------------------\------------------------------- <br /> ----------------If---------------------------------------/--------------------1-1--_ 7---------------------------------------------------------------------------------\----------------------------- <br /> --------------/--------------------------------- --------- ----/------------------------------------------------------------------------------------------------------------------------- <br /> (Draw exiting 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 Health District. Home 'Owner or licen- <br /> sed agentsgnature certifies the-to4lowing: I <br /> "I certify that in the`performance'-of-the work for whicll~thiCjiermit is issued, I shaIl_nqt_en1p1oy_any-Fi� such manner <br /> ­_—'67 <br /> as to become subject to Workman's compensati n law—s-4 California." <br /> Signed <br /> By ------- _ ' --- <br /> - ---- --------------f--------- Owner er <br /> ------------- <br /> ----------------------- ------------ <br /> -(if other than oTier) <br /> .W7 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ....40!!2 --------------------------------------------------- DATE �7!5.5;......... <br /> BUILDING PERMIT ISSUED ----------------------------- ---------------------- --------------------------------------DATE ------------------------------------- <br /> -- -------- --------------------------- <br /> ADDITIONAL COMMENTS -----41 ------ ------------------------------------------ ----- <br /> ------------ ----------------------------------- -------------------------------------------------------------------------------------------------------- --------- --------------------------------------- <br /> ------------- -------------------------------------------------------------------------------------------------- ------------------------------------------------------------------ <br /> ---------------------- P --------------------------------- - iY <br /> ------ <br /> Final Inspection by: ------------------------------U----------- --- I ------------------- ----- <br /> .Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />