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f-If—Z <br /> APPLICATION FOR SANITATION PEN.ATw.r Permit No. 0-90� <br /> (Complete in Triplicate) <br /> Date Issued 1 X;. 7 U._..- -,-/-y-_ __�, This Permit Expires 1 Year From 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION �l ,SEA" �Yex R��`!-r Tucl"_W'-__..._.......CENSUS TRACT ...._/...r......... <br /> Owner's Name ----------------------------------- -- - --.....Phone <br /> Address -Z)b5j---&-. k4zor*X,..14Y.6VfLf ---------------------•--. City vp 7(wvq-------------- --------------------------------- <br /> s y�L- o7 <br /> Contractors Name ....PW)46Z. .---------------------------.....---------------------.License #•ash---�3---- Phone .............................. <br /> Installation will serve: Residence ❑Apartment House Commercial XTra1let Court ❑ <br /> Mote[ p Other - --- -- ----- -----_---------. GG... <br /> Number of living.units:__.___. Number of bedrooms ............Garbage Grcinder�..... _._- Lot Size <br /> /it ,,e x S r <br /> ............ -, <br /> Water Supply: Public System and name ----- ---------- ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay LoamX - <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 ithin <br /> 00 <br /> PACKAGE TREATMENT g septic tank or SEPTIC TANK[� page pit permitted if k sewer <br /> e� available Liquid Depth 1. �� - <br /> Capacity J.;90 `►..-- Type R IZ4r[_ Motenal._..a CRWII� No. Compartments i, ................ p <br /> Distance to nearest: Well ._._... -_.._.................Foundation .......... Prop. Line _.. ........ <br /> LEACHING LINE [ ] No.Boof Lines - -OP Filter Material 2vyL line_____ Total Length _ 0�............._.. rn <br /> .......... Type ...Depth Filter Material .--- --------------- ..................... <br /> .. . <br /> ------- ------- ---- �a I........-- Property Line .._. <br /> Distance To nearest: Well � Foundation ...:-------- <br /> -' Number ':... -_---- . Rock Filled Yes No <br /> SEEPAGE PIT [ ] Depth .. .,..:..(Diarg/eter. :.; .��. A --. _ <br /> Water Table Depth ........4P,.'G---------------............Rock Size ------------------------------- . . <br /> Distance to nearest: Well _... .:........:.:...`Foundation __z Gi-------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----- -- _. Date .. ......) <br /> „1 t <br /> Septic Tank (Specify Requ�irementsl --- --- ------------------..-......-----------....._----------------- ......... ...............--..- --------------------------- <br /> Disposal Field (Specify Requirements) ------- ----- ....... ......... -----.--- ..---------------- \r-------- ----------------------------- ............... <br /> - , . -- . ' <br /> - -- - i .. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify,that I have prepared%this applicaticin and that the work will be done in accordance with San Joaquin <br /> County Ordinances, Stote 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 p�rmanc�f-the'wor or which this permit is issued, I shall not employ any person in such manner <br /> g - ..- California." <br /> as to become subject to Workman' Com n hon laws C <br /> Signed _ �W <br /> _.. ..- Owner <br /> ey -- .�� ' . .. -........ ;.._...- Title(If wner) ` <br /> ` FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <a .__.... .. O-// .0.p'Qt.------ ------ DATE ..�7c _ �1.G.... <br /> BUILDING PERMIT ISSUED ---..---_---------------- r-------------._DATE --------------- --------------------------- <br /> ADDITIONAL COMMENTS _..... -' -... .t: <br /> . ....----- - --- -- - - .. .------_ ------- ----------- - ---­------------------- ---------- <br /> !- <br /> --- . _....._... ... - - - / J- . - . <br /> +t -'/�- <br /> - - ---------------- -- - - 6- -- - -------- - ------I..... - ------------ ... - --------...,------ <br /> Final Inspection by: .----- .. . ... - ... - � -- - .. ---L - A. ----- . - - _...............-------Date .../z.-/I ...it------ <br /> SAN/JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1•'68 Re . 5M <br />