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FOR OFFICE USE: <br /> \PPLICATION FOR SANITATION PI IT <br /> _.-...... . ._... ._.........L�..:M1.:'...._ -• <br /> (Complete in Triplicate) PermltNo. .7�t.:.1/,j <br /> .................................... ......... <br /> ............ This Permit Expires 1 Year From Date Issued Date Issued .:i:.......:7G <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 compliances�with County Ordinance No. 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LOCATION ....7�E7E7. , .vim �I ���/ CENSUS TRACT ........I................. <br /> rr .. . .-... G V <br /> Owner's Name ......G. ..Phone Y.4 w <br /> Address . .......... ..... �± {}........,- -. City -..r ... .. . .. .............�/ / <br /> Contractor's Name .......... ..Ci..1.?,r ,/ ...................License # -`f <br /> ...... j Phone ..T..y!(06a 7 <br /> ... .......... <br /> _. .. <br /> installation will serve: Residence 0 Apartment <br /> HHloouuse❑ Commercial ❑Trailer Court a <br /> Motel ❑Other .. l_, /. !7.. <br /> Number of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size .............C ?? ..„..„... <br /> Water Supply: Public System and name ......................................................._................................................... <br /> Private` <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peot❑ Sandy Loom❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe�( FIII Material ............ If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on rewrm std..[ <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,[ <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size................................................ Llquld Depth ...........„............ <br /> Capacity .................... Type .................... Material.............. No. Compartmenh <br /> Distance to nearest: Well ................................. ..Foundation ...................... prop. Line_........._:.___. O <br /> LEACHING UNE [ ) No. of lines . ...................... Length of each line....................... _. <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material .................................... <br /> „. .. fi <br /> Distance to nearest: Well ........................ Foundation ................I....... Property Line ........................ <br /> SEEPAGE PIT [ J Depth .................... Diameter 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# ............................................ Date ......................„„....„[I � <br /> ` Septic Tank (Specify Requirements) ..:........... ...-........ L�..........,...... ................ ............ ...... <br /> Disposal Field (Specify Requirementsl ...._-( teF. -....y-y---.7..Q..... ....J` `'! [,,µn.................................... <br /> 1 <br /> ...............................................................•-,......._ ............... 'a�.......X..y:?..,...-. .�:tct¢r�(....�-S./...•_ . <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 fan J"civin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Hone owner or licen- <br /> sed agents signature certifies the following: <br /> "1 certify that In the performance of the work for which this permit is issued, I shag not employ any perm In sods manner <br /> as to become subject to Workman's Compensation laws of California.” <br /> Signed Owner <br /> . . --------------- ----------------------- <br /> By . ..._.-` .� ........ . <br /> - ........--................... . Title <br /> (If than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION AC EPTED BY /` .......... ......... .. .. 1. _............ DATE s3_ .z.... ;.7 ..........: <br /> BUILDINGPERMIT ISSUED ........._....._...... . ........................................ .--- .. ........................DATE ._.._ ...............................­ <br /> ADDITIONAL COM6g ......-. <br /> �.-/o^.-�6..-._....... .._.i._ -..... ... .� n.a�.Q......... JA. ......_.i. ....- s. iv><:............ <br /> ...... ............................... ........... ................. ......... .......................................... <br /> ......... ........................ ..... ....... ..............................• . ....... ....... ._..........--.........._... ....._._.......................................... <br /> FinalInspection by: . .. ...... .. �'""J . ......................................_ ............................Date <br /> .. .: . . . ................-... <br /> EH 13 2h 1-68 �: Sqp( JOAQUIN LOCAL HEALTH DISTRICT 9/� 3M <br />