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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />Permit . tiL <br />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 comp,I,Viith County Ordinsilge 50 exisiing Rules and Regulations: <br />-'6o yet • <br />JOB ADDRESS/LOCATION iiig544.14/ _/2,/ _, 42-,_,.e....,,,,,zu CENSUS TRACT <br />Owner's Name . _.(.44.,- <br />Phone . <br />Address /0-- 1/ -.4.-44-t-le City c244-- * <br />4,-4-- License # Phone <br />Installation will serve: <br />Motel El Other <br />Number of living units. i Number of bedrooms "41---- Garbage Grinder Lot Size /e...4,-, <br />Water Supply: Public System and name ---- ----- - Private <br />Character of soil to a depth of 3 feet': Sand 0 silt 0 Clay 0 Peat El Sandy Loam .0 Clay Loam <br />Hardpan E Adobe 1.1 Fill Material . If yes, type <br /> --------. ------. <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 septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br />PACKAGE TREATMENT I] SEPTIC TANK ¶] Size Liquid Depth <br />LEACHING LINE [ ] No. of Lines Length of each line Total Length <br />SEEPAGE PIT [ I Depth------------------Diameter Number Rock Filled Yes (:) No <br />Capacity Type Material ., No. Compartments <br />Distance to nearest: Well Foundation Prop. Line <br />'D Box . Type Filter Material Depth Filter Material <br />Distance to nearest: Well Foundation Property Line <br />Water Table Depth <br />Distance to nearest: Well <br /> Rock Size --- <br /> Foundation Prop. Line <br /> Date l <br />Septic Tank (Specify Requirements) ------ ........... <br />isposal Field (Specify Requirements) <br /> .. . <br />40.0 <br />(Draw existing and required addition on reverse side) <br />..... <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br />County Ordinances, State 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 performance of the work for which this permit is issued, I shall not employ any person in such manner <br />as to b me subject to Workman's Compensation laws of California." <br />Signed <br /> Owner <br />(If other tht;r1 ow er) <br />APPLICATION ACCEPTED <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS <br />Contractor's Name <br />A <br />Residence Erkpartment House El Commercial ET-railer Court .0 <br />REPAIR/ADDITION (Prey. Sanitation Permit # <br />FOR DEPARTMENT USE ONLY <br /> DATE <br /> DATE <br /> <br /> Date tzeo -16 .... <br /> <br />Final Inspection by: <br /> <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> <br />E. H. 9 1-'68 Rev. 5M