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FOR OFFICE USE: APALICATION FOR SANITATION PERMIT <br /> Permit No.;7o-- .Y3;(, 1 <br /> (Complete in Triplicate) a <br /> - <br /> - <br /> Date Issued 7------_c- .O <br /> ----_-------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and.install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and exist- g;Rules and Regulations: <br /> `� C� ` -Aa-_ NSUS TRACT -------------------------- <br /> JOB ADDRESS/LOCA710 . ---I-f�-� 0�-�-;----,/V-`--�--moi ��� Jam'-`-- <br /> Phone ------------------------------------ <br /> Owner's Name ----- - 1 }�� .f"JL _C°' `-------------------•-------- --- O''�� f <br /> r --•-•• City /Address y{� ------------------------------------ <br /> License #A ,.+��-4Phone���!.�d�f`� <br /> ----------- <br /> Contractor's Name f rV� W. f <br /> Installation will serve: ResidenceApartment HouseCommercial :❑Trailer Court <br /> Number of living un --I Motel ❑ Other--------------------------------------------- <br /> its:--/ <br /> --------------- ------------------------- -• <br /> /-_--- Number of bedrooms 9-_-____Garbage Grinder -��- Lot Size.Ar`- �`�--- <br /> Water Supply: Public System and name -------------------------- ----------- -------------------------------------------------=--------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Peat E] Sandy Loam Clay Loam ❑ <br /> Hardpan ❑ Adobe❑ Fill Material ------------ If yes,type _______________________---- <br /> 1 <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK Size-_!56 �1..................... ,:: .Liquid Depth I' CS <br /> %Capacityr-0j, ' . _,--- Type� Material No/Compartments <br /> Distance to nearest: Well --------------------------Foundation 42 Prop. Line ____-_.._ <br /> • ' LEACHING LINE No. of Lines ___. ---------- --- Length of each line d -.--- --- Total Length .4Z1�---F-----_---- <br /> ��� D' Box --jZYP <br /> e th ;Filter Material --..•-�-f---- - <br /> Type Filter Material` _ � p A V, <br /> /� zt7---�-------- Property Line.�, ' ......... <br /> �DistanFe.to nearest: Well _��______________ Foundation � <br /> ► j <br /> SEEPAGE PIT x] , Depth - -=-'~' Diameter 9-9------- Number -----�_------�_ _ Rock Filled Yes 'No i❑ <br /> ; -�- - _Rock Size , <br /> Water Table Depth -- � <br /> Distance to nearest: Well•.ov_pa_/------------- -Foundation __f��.--- Prop. Line ��.......-- <br /> %1" - , ------------REPAIR/ADDITION(Prev, ............ ---- <br /> ----- <br /> Septic Tank (Specify Requirements) _____________________ ---- <br /> I <br /> Disposal Field (Specify Requirements) --------------- ------------------------- <br /> -------------------------------------------------------.... <br /> -------------------------------------------------------- ------------------------------------------------- <br /> -------------------------------------- ----------------- I------------------------ ------- <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 /> da 1h <br /> I County Ordinances, State Laws, and Rules and Regulations of the San JoaquiWLocal'Heclth Disfrict. Home owner or licen- <br /> sed agents signature certifies the Following: <br /> "1 certify that in the performance of the work for which this permit is issued*1'shall not employ a-ny person in such manner <br /> as to become subject to Workman's Compe tion laws of California." <br /> S <br /> # Signed ----- ---------- <br /> -------------------- Owner <br /> Title ------ <br /> (If r than owner t <br /> FOR DEPA-RTMENT USE ONLY „v <br /> APPLICATION ACCEPTED BY ------------------------------------------------ <br /> DATE --- ��r�l ------------------ <br /> iBUILDING PERMIT ISSUED ------------------------------------- ---------------------------------------- ------ ---------------DATE -------------•-------------------•------- <br /> ADDITIONALCOMMENTS ------------- --------------------------------------------- ----------------------------------------------------------------------=--------------------------- <br /> ---------------------------------------- ----------- ---------------------------------------------------------------------------------------------------------------- <br /> ' f ------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------- <br /> ------------ <br /> ..r._ '"� ----- -------------------------------------------- ------------------------- ------ <br /> Final Inspection by '- Date _tel <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t E. H. 9 1-'68 Rev. 5M J . �, • - <br />