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FO.OFFICE USE: a <br /> i�t'PILICATION FOR SANITAYION PERF <br /> _ Permit No. ..73...... <br /> �-•- <br />................ (Complete in Triplicate) <br /> ...-' ............. Date Issued <br /> This Permit Expires 1 Year From Uate Issued <br /> Application is hereby made to the San Joaquin <br /> pp Y local with Cou Districtinarnce No,a per 5_49 and existing Rulesit to construct and talnd Regulations- <br /> described. <br /> egulat ansthe work rein <br /> described. This application is made-in,compl!once w Y <br /> E :. ... ..... <br /> ..0 N5US TRACT <br /> JOB ADDRESS/LOCATION ,� .IO�� :,• J { <br /> /"L f./'l.G ��' ?'..­--­----- F.............Phone .................... <br /> Owner's Name' ...... 'City _ ,! <br /> l -117_x.. , /�. _ <br /> Address ........... .... ......................... .. . s7r�s�` Phone r,..!... ..����. <br /> Contractor's Name ...... Lice License #Gn <br /> Installation will serve: Residence JN Apartment House 0 Commercial []Trailer`.0 a <br /> Motel-C3 Other ----------------­---------- <br /> /' �� -- ' F ................ <br /> Number of living units:...__------ Number of bedrooms ... ..._-__Garbage Grinder / Lat Size <br /> Private <br /> Water Supply: Public System and name ------------------------------------..................................................................... <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy loam fl Clay Loam D ; <br /> Hardpan 1­1 ` Adobe ❑ Fill Material _.,,�._... If yes,tyP <br /> (Plot plan, showing size of lot, location,of..sysfem in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: septic tank or seepage pit permitted within 2t30 feet,J <br /> ermitted if public sewer Is availa <br /> r _ Li quid De th <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size.. - `. ........:.......... q p D <br /> " . �..... ••-- <br /> Capacity .� � . Type ` . <br /> Material dleh.- No. ComF Partments, <br /> Well . Foundation .{f E ....---.... Prop. Liffe,... ..__...... <br /> •--• i <br /> Distance to nearest: _ �•, .:�:.-�. :� s <br /> 'Le th of each lin '-- •.------ Total Length <br /> LEACHING LINE , No. of Lines ._ g ... <br /> / � W Is <br /> 'D' Box -�ii�.. Type Filter Material .. De th Filter,Material -•................ <br /> p '> f s .. <br /> e .. <br /> � f <br /> r� '' Distan to-nearest: Well ...Rw-•-•.......=Foundation-.:..XVy..•.--•--- Property, ............ H_ <br /> Lin s <br /> Number `� - .Fil ed Yes No <br /> [ 1 Depth-, - •_:-Diameter ..--------- =-..,R k L7 <br /> SEEPAGE PIT -r- p �-=-:-:r.=------ ----•--•---..... 9 <br /> A Rock Size ................... .-- '.F. . <br /> Water Table Depth .----•-•--------------1............• . <br /> Distance to nearest: Well ----••-------•---•----- <br /> Foundation . :.. Prop. Line - ... - <br /> --- Date ...,.---••- � � • <br /> F REPAIR/ADDlT10N(Prov. Sanitation Permit q�----­------------------- <br /> \ r f <br /> Septic Tank (Specify Requirements) .....•-;.4.< ......I............. <br /> ..--:.....•---.W..........• - ....._.._..••---....... <br /> Disposal Field {Specify Requirements] �..•----- ------•�.... - -------••------...-- ti- = <br /> A <br /> ------- <br /> -----------------------------------•••..I-------- .......... <br /> `—^+ <br /> ........ ...... -=- .._ <br /> ---- -•--- -. ..._... ..._... <br /> (Draw existing and required addition on reverse side) � <br /> b I hereby certify that I have prepared this ,application and that the work will be done in accordo'nee 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 /> I as to become subject to Workman's Conipensatlon laws of Callfornia"--• <br /> Owner G % .. <br /> Signed : <br /> ......... <br /> r --'--•---•-----••-•.........:.: :title . _. _ .. :•.--------..... <br /> (If of r than owner <br /> i FOR DEPARTMENT USE ONLY <br /> 777 <br /> APPLICATION ACCEPTED BY ..... <br /> .............: .......................... <br /> DATE ••�1°...... ................. <br /> ..... .. <br /> I BUILDING PERMIT ISSUED ...I...:..- DATE _... <br /> ....-----••--•- --- <br /> ADDITIONAL COMMENTS - ..... -------------- <br /> _..: •.......................•-- --.. .._...:......__.._......_........ ._....._.....••.......-__..._....__... ..._............. <br /> ................ ....... : <br /> Date . ... <br /> : .. . <br /> = Final Inspection b ••- - -------------•---•---•-•---••---••--•-••--...-- <br /> �,� _SAN.JOAQUIN LOCAL•HEALTH DISTRICT - - <br /> . s <br /> 7/723 ,4 <br />