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APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />Permit No, 7 471- 1/2 <br />Date issued 5-- 'V".7(.7 <br />JOB ADDRESS/LOCATION 4 / 3 en? <br />Owner's Name ... <br />Address 0.7 71. <br />Contractor's Name <br />Installation will serve: <br />ove-••€- CENSUS TRACT <br /> Phone <br />City <br /> License # Phone <br />Residence Apartment House 0 Commercial 0Trailer Court 0 <br />Motel 0 Other <br />Number of living units Number of bedrooms Garbage Grinder Lot Size <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 0 Sandy Loam Clay Loam 0 <br />FOR OFFICE USE: <br />Hardpan 0 Adobe 0 Fill Material if yes, type <br />6; <br />Capacity Type Material No. Compartments ....0 <br />Distance to nearest: Well Foundation Prop. Line 0 <br />LEACHING LINE [ ] No. of Lines Length of each line Tota Length " <br />2- <br />'D Box Type Filter Material Depth Filter Material <br />SEEPAGE PIT [ ) Depth Diameter Number Rork Filled Yes r' L.., l No C)21( <br />Distance to nearest: Well Foundation Property Line • <br />/ <br />Water Table Depth Rock Size / <br />Distance to nearest: Well Foundation Prop. Line la <br />, <br />REPAIR/ADDITION (Prey. Sanitation Permit # Date I . <br /> 5C Septic Tank (Specify Requirements) -.. <br />Disposal Field (Specify Requirements) 4.-age-31 A 6:147C---":- (4-1---r—% <br /> )P--t' 1 ,1--*--r.-F4 -1•'-'42 <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 cutardance with San Joaquin <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Distrid. Home owner or Ikon- <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 become subject to Workman's Compensation laws of California." <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.1 <br />NEW INSTALLATION: (No septic tank or seepage pit permitted if 'public sewer Is available wItt in 200 feet) <br />PACKAGE TREATMENT [ ] SEPTIC TANKI ) Size Lig Jid Depth <br />Signed <br />By <br />(If other than owner) <br />Owner <br />Title fewin.„ <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY .... <br />BUILDING PERMIT ISSUED DATE <br />ADDiTIONAL COMMENTS <br /> DATE sr 02"1 .7 '9 <br />Final Inspection by Date 7-7-7Y <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />7/72 3 E. H. 13 241..68 key, 51,A