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Permit No. a + <br /> <, FOR OFFICE USE <br /> APPLICATION FOR SANITATION PERMIT ] ` <br /> (Complete in Triplicate) �J� <br /> ' - Date Issued <br /> .. . ... ... This Permit Expires 7 Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein H'rn" " <br /> described This application is made in compliance with County Ordinance No 549 and existing Rules and Regulations A � <br /> ` � / 4`.3� /. . ,r.... .. ... __. CENSUS TRACT ADDRESS/LOCATION iQG4 T ` <br /> Owner's Nome h.Lam.fJ ,l.y�..r/ ,f,7j.......... ..._ .. _ .. .:..:_. phone <br /> Address - .... ......... Gly -;;77T <br /> j Installation will serve Residence Apartment House❑ Commercial s )#a l��0 9 2. Pore y«.,Z6�s,ll ryty tv 5F <br /> Contractors Name <br /> er <br /> Motel ❑Other......................................... <br /> r <br /> Number of living units....!...... Number of bedrooms ..Garbage Grinder .Z..f. Lot Size ......./.Z,SJC� <br /> Nl __... ri. <br /> Water Public System and Home .. ............................ ..::...._ .. .....::. . P 'vate$' <br /> " a <br /> Character of soil to a depth of 3 feet: Sand p Silt❑ Clay ❑ Peat❑ Sandy Loam X C oy Loam ❑ , <br /> _- HarcIpan❑ Adobe ❑.. Fill Material ._ If yes,type ._. <br /> (Plat pion, showing size of lot, location of system in relation to wells, buildings etc. must be placed on reverse s del <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> ' PACKAGE TREATMENT ) 1 SEPTIC TANK( ] Size ........ _.. :.... __ Liquid Depth . .. 'JY�x�N <br /> .. <br /> Capacity .. Type ...... Material.- ...... No. Compartments <br /> . <br /> Distance to nearest Well . . .... ;.Foundation .: .... Prop Line . T, <br /> LEACHING LINE f ] No. of Lines ._ . ...... Length of each line:. . . To•al. Leng•h <br /> 'DBox . ._ Type Filter Material _- .. ..Depth rlher Material <br /> i Distance to nearest: Well ... Foundation . Property Lin- . i+ <br /> SEEPAGE PIT ( J Depth Diameter Number Rock F (led ves'❑r No`s' <br /> _ <br /> Water Table. Depth . ...... .::.Rock Size <br /> Distance to nearest, Well .... . - .. ... ......Foundation Pr r ra ., t:^.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit d6 ........... ........._.5 ....._...... Date <br /> Septic Tank (Specify.Requirements) ....... . ../, / ... .:.. ....../ -.. . .':"' <br /> Dsposal Field (Specify Requirements) ..9Q.d. <br /> l <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will he done In accordant with San Jeaq'in <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Distri<t!Home owner or IINn-,� <br /> sed agents signature certifies the following: v}' <br /> 3i4 :,tit <br /> "I certify that in the performance of the work for which this permit is issued, I shop not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -.. . _ Owner 7 <br /> .. / ..... ..... .?'.. <br /> By,. ,li G 'G .._ __ Title <br /> pf IF� <br /> of n owner) <br /> FOR.DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..... ft /L �Y 2(GG� ws DATE .G I v <br /> BUILDING PERMIT ISSUED .- ( .............. <br /> . _.. DATE :-; <br /> ADDITIONAL COMMEN,S .. ._. - .. - <br /> . . ... .... .. . . .. <br /> Final Inspection by .. . - .... .. .x/ 1.1./�i. cCy/su"%zr. .... .Date <br /> SAN JOAQU1N.. CAL LTF11!TRbCT ,y <br /> E. H. 9 1.'68 Pe'. SM <br /> I <br />