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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 99 i <br /> ----- -------�`: ;�-------------------------- (Complete in Triplicate] <br /> _3 .....�-w Permit No 71✓- j <br /> ---- -- I-------------------------- Date Issued <br /> ----- --------------- This Permit Expires 1 Year From Date Issued I <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 /> /, -- - --- ML �7`� -.,__ CENSUS TRACT •Z e" ------- <br /> JOB ADDRESS/LOC ION .-- - - �'�_- -r� - ----��---------�T ------ Sus <br /> ------�-Phone -i--------------------- �------ � <br /> Owner s Name ._ ! - - <br /> Address __._ f '---------------------------------- --------­­ City S. -T L�f1i9_Y-=------------'------------------- -------------- <br /> Contractor's Name __.._SPS-� <br /> License # ------ --- ---- Phone ------ ----------------------- <br /> Installation will serve: Residence partment House^❑ Commercial :❑Trailer Court ❑ <br /> `Motel:❑ Other ---- <br /> 60 <br /> Number of living units:_._f___.__ Number of,bedrooms - Grinder---_._ Lot Size _�-�7-�1 -------------- <br /> ----'s, a d.- ' Private i <br /> Water Supply: Public.System and name 1P1/5- `= ------ = =------------- r ; P ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay [❑ Peat ❑ Sandy Loam ❑: Clay Loam "❑ ' <br /> Hardpan ❑ Adobe'ErFill Material ------------ If yes, type __ _________ ____________ <br /> (Plot plan, showing size of lot, location ;of system in 'relations 4o wells, buildings, etc. must,164.placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seep ;pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f ] SEPTIC TANK'[ —size---.--- _ _______°- ------------ Liquid Depth ------- !.---____,_.--- �] <br /> Capacity 1. C2O------- Typ Material ire— No Compartments7 <br /> Distance to nearest: Well _____�___________ _______Foundation -+3L�-_ -__Wt-___ Prop. Line'.______ __...___ <br /> LEACHING LINE [gl/No. of Lines ':----1___.______----_ Length of each line.___t/ ? ._-___-____ Total Length :_A�_ __________ <br /> 'D' BoxD.e Depth.-Filter Material '_---- -�1- ------------------------ ---- <br /> - - • -- <br /> Box ---- Type Filter Material __ ____________ _ � <br /> � <br /> Distance td.nearest: Well.-._,-_,__>._:___:___°�:_ Foundation ------_---__---Ztoperty Line _�` <br /> SEEPAGE PIT [If""' Depth --____ Diameter ►�3��__-_Number --------/------ ---------- :Rock Filled Yes M-1--No f[] <br /> Water Table Depth ----------------------- ------------------!-----Rock Size -- I---------1--------------- <br /> ;t <br /> Distance to nearest: Well __---_—__°_._____ -" a_______Foundation Z ---- Prop. Line _ ________________ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------f---------.__ ._________-_-•-} <br /> Septic Tank (Specify.Requirements) ------ ---- 4 ,! <br /> -------------------------/-------------------- --- - <br /> Disposal Field (Specify Requirements) _ `�' 5--+'i C9Y'___-.11- --------_--- <br /> IrYr�rr U2.-------------------'-------------------------- ------------------------•--------- <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 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, 1 shall not employ any person in such manner <br /> as to become s =ct to ork an's Compensation laws of California." <br /> Signed ------ Owner <br /> BY ---------------------------------------f---------------------------------------------- Title --------------- ---------------------------------------------- --------- <br /> (If other than owner) <br /> F R-D PA MENT USE'ONLY <br /> APPLICATION ACCEPTED BY --------- ------____-- ------------ -- <br /> DATE lD--2 7_21------------ � <br /> BUILDING PERMIT ISSUED ----------- ----------------- =---DAT ------------------ ----------------------- <br /> ADDITIONAL COMMENTS ---$`�- --- ._ __1� -�-� -�", �� -� <br /> - � ' <br /> ----------------- -- ----------------------------------------------------------------- <br /> --------------------------------- - --------------------- ' <br /> ------------------ ---------------------------------------------------------------------------------- <br /> --- - -- ---=-- <br />`, Final Inspection by: =t ------------------- --- - -- ----------------------------------------Date __ /._.,--------------------------------- <br /> SAN <br /> . -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />,i. <br /> E. H. 9 1-'68 Rev. 5M <br /> L1. _j <br />