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4-0�. <br /> FOR OFFICE USE: F 7 - <br /> APPLICATIONyIF9.VSANITATION PERMIT <br /> ----------­­---------------------- <br /> (Complete in Triplicate) Permit No. ---'7.)-- --------- <br /> ---------=----------------------------------------------- <br /> ____----------------------- This Permit Expires 1 Year From Date Issued bate Issued -- �� _ <br /> Application is hereby made to the`San Joaquin'LocallHealth 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/LOCATIONRD----------------CENSUS TRACT .—�_�1........ <br /> _ o <br /> Owner's Name ,4- - __-- Phone <br /> Address -------#747'-------A&PT %/J -- <br /> - - -- --------- <br /> Z City��r/ - -------•------ <br /> Contractor's Name...... `. <br /> Installat.ion4will serve: Residence ❑ Apartment House,❑ Commercial ❑railer Court - i;� <br /> Motel ❑Other --------------------- 1 �,_ �- Alp Y'�E /-}OM>�S�(PORM) <br /> Number of 4k*mg. units:__ _____ Number of bedrooms _9_______Garbage Grinder _._____.__ Lot Si4._1.�.__A <br /> Water Supply. Public System and name ✓� _ _ Fpm' � � <br /> - T-==s -- -- -�----------- -----------------r------=----._.....-----.Private <br /> Character of soil to-a depth of 3 feet: Sand' Silt❑ Clay ❑"IPedt❑ Sandy Ld6rf []---Clay Loam❑-- <br /> Hardpan ❑ AdobeA[ 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,reyerse,side.l <br /> NEW INSTALLATION: (No septic tank or seepage permitted if public.sewer is available within sOd feet,) �l <br /> ' 0 <br /> PACKAGE TREATMENT [ SEPTIC TANK Size_ ` 10_x:, _______ Liquid Depth --. __ ___________ <br /> Capacity6__-_Q_ __ Type PICaterial ?Ai°LFSrNo. Compartments . _ <br /> r ----- • . <br /> istance to nearest: Well`------�-------------- <br /> `f _____,__ , undation __��_T Prop. Line .__ <br /> / < <br /> LEACHING LINE No. of Lines 0_____________ Length of each IineF f�_Q_____.__._-- Total Length ,__ ---•-• - <br /> D' Box _ES Type Filter Material _4K0_e1-_Depth Filter Material ---------------- <br /> Distance to nearest: Well -IQa____________�foundation Property Line __-----________.__._.__. <br /> SEEPAGE PIT [ ] Depth ____________________ Diameter -----------e=____'Number ---------------------------- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ------------------------------------------------Rock Size ------------------- <br /> Distance to nearest: Well _____________` ____--_-..__---_--Foundation -------------------- Prop. Line _._.____-.___......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------.. ,- ,y <br /> Date -------------------------------•--} <br /> SepticTank (Specify Requirements) ----------------------------- --- ---- - `;.:-------------------------------------------=---------------.•-------------- -•----------- <br /> Disposal Field (Specify Requirements) ..� -- - -------------- ------- ------------------------------------------------------------------------------------------ <br /> 1- <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 Rules3and Regulations of the'San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the foilowing:! l <br /> "I certify that in the performance of the work for which thisipermit is issued, I shall not employ any person In such manner <br /> as to becomes ject o Wo kman's Compensation laws of California." <br /> Signed __ . . Owner <br /> By ------- -- --------- -- ---------- title -- <br /> --------- - - <br /> (If other than owner) <br /> FOR+`+,cDEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..._At � <br /> - ` -`------------------------ - ----------- ------------ 7- <br /> ------------------------ DATE --- - : ` `7�.� <br /> BUILDINGPERMIT ISSUED ---------------------------------- ----------------------------- -------------------------------------DATE _----------------------------------------- <br /> ADDITIONAL COMMENTS - - = <br /> ---------------------- ------------ ---- _ - - ___ ---- ---------_____-_--_-_----------------- <br /> Final Inspection _______ __•-_____ _� <br /> Date _... T � � <br /> SAN JOAQUIN LOCALRHEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M l J°a <br />