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-r'FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> . Permit No. ..75/�73 <br /> (Complete in Triplicate) <br /> ......................................... <br /> . ........... This Permit 1 Your Date <br /> Dote Issued <br /> ............. .............. -. .:. . <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 <br /> COrdinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATI /..JI444 <br /> .X,f...........................................CENSUS TRACT ....................._... <br /> .Owner's Nome .. ... ... ..................................--- 0 ......\ t/— � /JJPhone .. _...... <br /> Address ................ .... ........ . city . . ...................._._. <br /> jaa <br /> Contractor's Nome ..... ... . .� ....C1. JA-- <br /> . .................License #fit .3 ..'✓. Phone :.................._......... <br /> Installation will serve: Residence ❑Apartment House Commercial❑Trailer Court ❑ <br /> Motel ❑Other ......w�,r-*10141..........4-------- <br /> Number of living units;............ Number of bedrooms ............Garbage Grinder ............ Lot Size ...... <br /> Water Supply: Public System and name ........................................................_.......................................... .........Private <br /> Character of soil to a depth of 3 feet: Sand❑�ilt❑ Clay C-] Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan Adobe❑ 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 reverse side.) <br /> NEW INSTALLATION: (No septic tank or see ge pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size..T/ l��I-.....JI._.5... Liquid Depth ....T..................... <br /> Capacity A... Type L.IRfs .4:�' - - - <br /> Material...�rir..�.. No. Compartments ........_........... <br /> Distance to neo st: Well ...........A Q. ...............Foundation ..... .... Prop. Line.....`2......_.......J <br /> LEACHING LINE [q/No. of Lines ...../................ Length of each line....... ................ Total Length .. U.-_.............. <br /> .:,J <br /> 'D' Box .... ... Type Filter Material .....4F_eg.....Depth Filter Material ...... .......................... <br /> 5 <br /> Distance to nearest: Well ....../fJ..,7......... Foundation _ ........ Property Line ...................... <br /> i <br /> SEEPAGE PIT [ Depth ....PZ..5..... Diameter ....3 3 Number ..........�............... Rock Filled Yes �No Q <br /> �••.........................Rock Size -� ."X 3...---- <br /> Water Table Depth .............�... <br /> Distance to nearest: Well .........2........,S—o <br /> ....................foundation ---.o <br /> .. .... Prop. line ........._.__..._ I <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ................. .......................... Date .................................I tLy' <br /> Septic Tank (Specify Requirements) .............................................r......................._................................. e <br /> Disposal Field (Specify Requirements) ......-•-•--------...----•................................. --............................. .................................. <br /> .......----...._........------.......................'..._..•••••-•......................................_._..................'•-•••.-...................................'--------. ..............00 <br /> - _....._............................................................................-- ......................................................... ... _. -................OQ <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 Health 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 .............................................. - --. Owner_ <br /> I -................... <br /> By ..................................................ne -/�'�"'--�.... �-�.--. Title ...... ..................- ---•.---•--...... ............. <br /> (If other than owner) <br /> [[�t FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY......................C.:..:..........................---....------•.........................--_. DATE ....�. ..1l. ..7 r,�............ <br /> BUILDING PERMIT ISSUED ....... r� �......... DATE ............ •--••--•---.................. <br /> ADDITIONAL COMMENTS .... �/..4Q�(..Z.y......r 712.LCA......... .............................._..-_.................................. <br /> -.............. - ..................................----................. •• ...... . ._.............•..... -- --.............• .-----------.._............`---......... .. ......... <br /> ...................I... ---................-•---.................:..---............................--------.......-........................---•--.._....................... <br /> - ........... <br /> FinalInspection by: ..............•- '---......._....._....---...,................._...................................Oats ....1'.s.&: ; ..,7. _............ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT r� <br /> E. H.13 24 1-'68 Rev. 5M -7¢723 +K , <br />