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7 <br /> FOR OFFICE USE, <br /> .......... APPLICATION FOR SANITATION PERMIT <br /> ........................................._ . .................................. <br /> .... <br /> ..".... .. (Complete in Triplicate) Permit No. <br /> ........................................................... This Permit Expires 1 Year From Date Issued Date blued - cf� ' �� <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 1s made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ' JOB ADQRESS/LOCATI �,� <br /> .r+,►. .T. . .... CENSUS TRACT ..S�.N/...... <br /> Owner's Name ... .✓...... <br /> Address .. � � •••�..�'�.-... <br /> .T.........�P.,�cic,....-..P .a .. <br /> a Contractor's Name .. ,. , .., if�,r , i,.SX. it,v.S....... License Phone IV47.r-I 41ple.. <br /> Installation will serve, Residen ortrrient Houseb Commerciol'[]Troiler Court <br /> _. Motel 0 Other ti <br /> t Number of living units,...... . Number of bedrooms ..•f!!......Gafba a Grinder //ff <br /> J g Lot Size nc�.�.'S <br /> Water Supply, Public System and name ..................................... . "' " <br /> .. <br /> Character of soil to a depth of 3 feet, Sand❑ Slit 0 Clay C3 Peat <br /> Sandy Loam Clay Loam [� <br /> Hardpan j] Adobe�Fill Material If yes, type <br /> ............. <br /> (Plot plan, showing size of lot, location of system in relation to wells, building--, etc. must be placed on reverse side.) <br /> ------------- <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK <br /> { ( ] Size....................... Liquid Depth ......;................... <br /> Capacity . TT <br /> YPe ................. .. Material No. Compartments <br /> Distance to nearest: Well . .. . f <br /> 1A . ..................Foundation Prop. Line . <br /> ,V 1, LEACHING LINE O No. of Lines . ......... length of each line <br /> Total Length <br /> ' Box ......._. . Type Filter Material .............. .....Depth Filter Material <br /> ....................._....._.. <br /> Distance to nearest: Well ... . _.. Foundation -- ....... <br /> 1 <br /> Property Line -...;__ . <br /> SEEPAGE PIT <br /> [ ) Depth ........- ... Diamote -.... Numbe• <br /> Rock Filled Ye:.+[] No Q. <br /> • Water Table Depth .............. ................................Rock Size <br /> Distance to nearest: Well ....... . I <br /> Foundation Prop. Line ..+...._............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........ .--. <br /> .......... .............. ... Date ) <br /> ...:................. <br /> •§eric Tank ,Specify Requirements) . ... . <br /> .. ( Dis sal Field (Specify Requirements) - � _ J <br /> (DroW existing and required addition on reverse side) i I� <br /> I hereby ocortify that I haft* prepared this application and that the work will be done in accordance with Sion Joaquin <br /> County Qtd(nonces, Stats lbwstianj Rules and Reg+ions of the San Joaquin Local Mealth District. Home owner or lion- <br /> sed ag ` s dgQature certifies tla following: ( _ <br /> "I/ortifthat in the performance of fhs w k for which this permit is issued, I shall not e-ploy <br /> to befome subject!o Workean's Com etlsatlon la sof California." P y °"y person in such manna. <br /> 4.: K <br /> r <br /> 19ned . ..... ............... .�. .._,. Owner <br /> k Ilf other Title , 1���. <br /> ....................t.. - <br /> t in owne, . . ............... <br /> EOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. -- ` <br /> BUILDING PERMIT ISSUED . _ _. - . . .. .I........ t - UATE <br /> ADDITIONAL COMMENTS ....... _ <br /> DATE _............... <br /> _ . . ............................... _-......-. _.... ........._.-. - -... ._. <br /> _. ... - <br /> =' Final Inspection by: <br /> O.-.... Dute�i � J� <br /> SAN JOAQUIN LOCAL HLALTH DISTRICT <br /> F. 11 9 1-'68 Rev, 5M <br />