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oR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> --- 3" —�-- Permit No.. <br /> -------- -'-------- <br /> -------- <br />� [Complete in Triplicate) <br /> --------------------------------------------- <br /> . Date Issued .'1) _-"247 <br /> This permit Expires 1 Year'From Date Issued <br /> Application is hereby made to the San\Joaquin Local Realth District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordnance No 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATIO ----CENSUS TRACT -------------------------- <br /> Owners Name ---------�- ---s-- --�"" <br /> �_L<L�_�_P�- --------Phone 7 <br /> Address -jf G Nv_. City <br /> -- <br />" .lv ✓5 License # �T�SI/p Phone 6 <br /> Contractor's Name __.___--. -- - <br /> Installation will serve: Residenc6yApartment Hou wgCommercial:07railer court ❑ <br /> Matel-0 Other, ------------ ----------------- <br /> V{� - [ e'. <br /> Number of living units____-____-Nur'ber of bedrooms ______ ___ 1 <br /> l .Garbag Gri a Lot Size <br /> { .�� `� Private ❑ <br /> Water Supply: Public'System"and name ---------------- - ' <br /> i P6at Sarid Clpy Loam_❑ <br /> 4 Character of soil to aA4pth_of 3 feet: Zand ❑ Silf-El—Clay':❑' -❑" Y <br /> Loa <br /> ' 1 1..- _15 <br /> e Hard an; „�.�Adobe.y❑. .Fill_Materiaf <br /> ------------- If yes, type --------------------- <br /> (Plot plan, showing size of lot, location of system-,,A (elation to wells, buildings-1-e c. jnust be placed ont reverse side.} <br /> 414 <br /> NEWJNSTA EATION: (No septic tank or seepage pit pe mitted if public sewer is available within 200 feet,) \ <br /> t L4 <br /> PACKAGE,TREATMENT { ] SEPTIC TANK'[ ] Size--------------------------------------------- Liquid Depth -----------------•--.----- <br /> Ca acitY - Type --------- l--- ---- -------- No. Compartment ------•--------------- <br /> Materia <br /> { Distance. to nearest: Well ----- ---- ------------ ----------[Foutndation ---------------------- Prop. Line ---------------------- <br /> Tot <br /> ------------ <br /> LEACHING LINE . [ ] <br /> No. of Lines ----------- Lengthi of each line------ -------------- <br /> ----- 7otdi Length -- -------------•----------- <br /> qa _I_De th Fi{tet°Material --------------------- <br /> 'D' Box {---- --- TYpe�.Filfer�Mat�rial�.�------- ------- - --�-------------------•------•------••----• <br /> Distance to nearest: Well ________________________ Foundation ---_____-----_____---_-- P1operty44 Line __ <br /> SEEPAGE P1T. [ ] Depth[ -------------- -- -- Diameter ---------------- Number -_------:-------------. __. Rock Filled Yes C] No <br /> i <br /> . .Ci Water Table Depth -: Rock Size <br /> Distance to nearest: Well -------------------------------------- ,.Foundation ------------- ------ Prop. Line <br /> ) __---------_----.----- <br /> REPATION'(Prev. Sanitation Permit# gate --------•-----------------•-- <br /> ----- <br /> ------- <br /> Septic Tartk_(Specify Requirements) -- - <br /> ---------- -------------------- -------- <br /> �"me <br /> . s <br /> Dis osa! Fieldw{SpecifY Re u <br /> -------------------- -------- <br /> �.. f` <br /> ----------------- ------- <br /> ------------------------------- <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 accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the S.an,JiIaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the4foll6viii , <br /> N 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." ' G <br /> Signed -------- -------- - --- Owner <br /> Title <br /> ------- <br /> BY ---- <br /> (If <br /> r <br /> r than owner) <br /> 'FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---- 44-,>e-a 4d ---------------------------------------------------------------- ---- DATE 3 - ------------------- <br /> PERMIT ISSUED ----- -----------------------,DATE -------------•----- - -------------------- <br /> BUILDINGir <br /> I ADDITIONP,L COMMENTS _�_=.-2J- a__ ,�. 0 .�----- --. - ��s..�1� --------- <br /> 7p`+GPA I,fd 10 <br /> ----------------------------------------------------------------------------------------- <br /> -----------------------------------------------------------//----- ------------------------------------------------ --------------------- <br /> �.w ----------------------------------------- --ate_-- = <br /> ------------------------------------- <br /> Final Inspection by; ----��--"-��---------------------------- -------•-------- ---------• ---------------- <br /> ------ gate - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M f <br />