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FOR OFFICE USE: <br /> c APPLICATION FOR SANITATION PERMIT <br /> -- ............ ........ Permit No.-1/----_71—3 <br /> -"-- {Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued .. .-'. .:.7/ <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 my Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ------------- -------461 L e- -- ENSUS TRACT .-----_-.._` <br /> Owner's Name ." .». ........ .>WY`N.Q�.:GF��'....................................... . .._... ------------Phone -$.©- <br /> Address --------4_ O�A- -------S---------•-- -0-�"-.�.... . .- - -----------. City --S-l-►�L...........--------------------------------------------...... <br /> Contractor's Name ------------..................._-----------------------------------------------License # ------- --------- Phone .... . -............-------- <br /> Installation will serve: Residence [Apartment House❑ Commercial❑Trailer Court i❑ <br /> { Motel ❑Other------ .................................... p� <br /> Number of-vshg units:__.._.. Number of bedrooms -%""--"-Garbage Grinder LAI". Lot Size ....Q. _._a.$.1.1-er.4..------ <br /> I I Water Supply: Pudic System a_nd name -----.---------------........._._........."......._..._...................._.---------------------Private <br /> Character of soil to a depth of 3 feet: Sand I-] Silt❑ Clay ❑ Peat❑ Sandy loam ❑� Clay Loam A <br /> Hardpan[� Adobe Q Fill Material ..'........ Ifyesttype......._................... <br /> r;. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings etc(,must be placed on reverse side.) V <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer+is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK , '/ O r , <br /> ( 7 L�1' Size.-------- --X � - -- -- - Liquid Depth . - - -- -- <br /> p <br /> Typa Material..-... <br /> Ca acit � — . No. Compartments _2 -."-.,.."" <br /> p y .... .... . �^ <br /> -------- r.. <br /> i Distance to nearest: Well -------- Foundation '`.'.=.. Prop. Line.............:........ <br /> LEACHING LINE [ ] No. of Lines _.st. ........... ... Length of each line...S.S_ It- _-t.Total Length ----Iy[i------------- <br /> 'D' Box ._ ... Type Filter Material Sr ?*. ..Depth`Filter Material :....�g��._.......... . <br /> Distance to nearest: Well ....LC*!. ..T�A "_ .. perty 4dJ--"" --------. <br /> "._-. foundation ..-_. ._... __ Pro Line " <br /> SEEPAGE PIT ( ] Depth ".�a= _. Diameter y_,k R-----. Number ......Q------ ---_.--_. Rock Filled Yes " No 0' <br /> $WMF1S Water Table Depth ...1JU-1. rt �..................... <br /> .. ........... ---- -----Rock Size . .-.. <br /> Distance to nearest: Well .189 __--------------------Foundation .�$. 4'------- Prop. Line .-.1 ..... <br /> GG , <br /> REPAIR/ADDITION(Prev. Sanitation Permits.# .................................._....... Date "."...............................) Y/1 <br /> i� <br /> Septic Tank (Specify Requirements) ------------- ' - -----:1. ----------------------- --------- --------............ <br /> Disposal Field (Specify Requirements) -------.--- /.------- <br /> cyl-------------------------------------------------------------- i <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have preparid,this application and that the work will be doneiq .accordance with Sart Joaquin <br /> County Ordinances, State Laws, and Rules and-Regulations of the San Joaquin Local Health'Diltrict. Home owner or licen- <br /> sed agents,signaturecertifies the following:', ty ?ice �, <br /> "I certify that in the performance of the work'for t4hich this permit is issued, 1 shall not empiigy s(hy-.persoW in such manner <br /> as to become sable Work n's Compensation.laws of California." J V <br /> Signed �� - '�.'.�%' .--..y _`Owner <br /> By .._.................... -- -- - ------ - --- -------. Title ---- ----- -- - <br /> (if other than ow, r) <br /> �- FOR DEPARTMENT USE ONLY ) <br /> APPLICATION ACCEPTED BY ... --- . -- ---- --_--- --- --1 . -------------------------- DATE <br /> BUILDING PERMIT ISSUED .... ------- _--- ------- .. .....................................DATE ..................................... <br /> ADDITIONALCOMMENTS -----..............................._------------------- - ------------------- - - - ------ ---------- -------- <br /> ...:..........----------------------- ------------------------------._----.._. ----- --------..................... -­---------­-- ................ <br /> Final Ins ection b __ ......".-_.....Date _. <br /> P Y: ..... .... ..................... --- ....._ - .... <br /> - -- - -- . . <br /> li SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.'9 1-'68 Rev. 5M <br />