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FOR OFFICE USE. V FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. 7r{-Sd f <br /> (Complete In Triplicate) 6_ 2T 71 <br /> 'I Date Issued . <br /> This permit Expires I Year from Date Issued <br /> A:,f, on is hereby mads to the San Joaquin local Health District for a permit to construct and install the work herein described. <br /> TI• ppl,canon is made in compliance with County Ordinance No.549 and existing Rules and Regulotions: <br /> X76 7 � CENSUS TRACT <br /> ewriiNADDRESS LOCATIJQ�fJ., dada-) Phan. q3/-367 _ <br /> O•Nnnr s Nome S 7� • o' - • � f�i fl-4. _ _ .Zip _ _ _. _. __ <br /> A.idrnss � �C�.✓/ift.�..ties7' city �1�LA-�w�so-s�'r SFbL.-�do7 _ <br /> Contrac•or's Nome ct= C Saxes License N s' .3 ; Phone <br /> Installation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other <br /> T <br /> Number of living units: Number of bedrooms � Garbage Grinder .. Lot Size .. . ; <br /> ..Private <br /> Water Supply: Public System and name - -- - - ' <br /> Chcracter of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam ❑ I <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 pewit on reverse side) 0'Q <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is Ovailable within 100 feetp <br /> PACKAGE TREATMENT [ ] <br /> SEPTIC TANK I ] Size . . . .. ..___:'Liquid Depth .. s <br /> Capacity Type <br /> Material - No. Compartments - - <br /> Distance to nearest Well . ..... .__.._ <br /> . ___.._Foundation .- . ...........Prop. Line . <br /> LEACHING LINE [ ] No. of Lines .. . .-ILength of each line•. . <br /> . Total Length <br /> -- - <br /> 'D' Box type Filter Material. . ... Depth Filter Material <br /> .Foundation _. Property Line - - <br /> Distance to nearest:Weil_ - � 1Rock Filled 'Yes❑ No❑ <br /> Rock Size _ . .. <br /> SEEPAGE PIT l ] Depth ,. Diameter . .Number -. - -- - <br /> __ . - <br /> Water Table Depth __ ��- ' '1 <br /> Distance to nearest:Well - � - <br /> ..Foundation Prop. line <br /> REPAIR/ADDITION (Prev. Sanitation Permitew. .. Dote 1 <br /> Septic Tank [Specify Requirements) <br /> i <br /> D¢posol Field (Specify Requirements). <br /> (Draw existing and required addition on reverse side) <br /> I hereby codify that I have prepared this application and that,the work will be done In accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature coMfles 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 as - <br /> to become subject to Workman's Compensation laws of California." <br /> Signed Owner <br /> By ��( Title ��4• - - - <br /> r iv <br /> o er than owner) � <br /> FOR DEPARTMENT USE ONLY <br /> -y( ---- <br /> —_-- _ DAT <br /> APPLICATION ACCEPTED BY - DATE <br /> DIVISION OF LAND NUMBER - "' "' •" <br /> ADOITIONAL COMMENTS <br /> X0-5-'1a�c <br /> .. ! ... .. Date ° <br /> Final Inspection by: ��° rss star nv. me sM <br /> ,H 13 24 SAN J QUIN LOCAL HEALTH DISTRICT <br />