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FOR OFFICE USE: <br /> , e -4 . ' '-A V <br /> APPLICATION FOP. SANITATIONIFE' MIT <br /> ................................... <br /> Permit No. .'1? <br /> (Complete in Triplicate) <br /> ............. ...................... <br /> .......................................................... This Permit Expires I Year From Date Issued Date Issued J.---L.,...A <br /> • Application is hereby made to the'Son Joaquin Local Health District f'or a permit to construct and instal] the work herein <br /> described, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATIO ........ CENSUS TRACT .............. <br /> ............. .................... <br /> Owner's Name ....... ... ..... Phone ................. ........ ........ <br /> Address ....... Cit --------------- ...................................m......... <br /> Contractor's Name .............................................. .............................. # ............ Phone ...................... <br /> Installation will serve: Resiclence:�Apartment House C),Comm' ercial oTrailer Court 0 <br /> Motel 0 Other�........I...........x...... --------- <br /> Number of living units: -------Number,*frbedroorns '.�P--_:..Garbo e 'Grinder ------------ Lot Size ............................................ <br /> Water Supply: Public System and name ------•-----,--••-----------•--•_••..----•- ------•-=•---------------------------------------------- ........Pr.ivateJ0,11 <br /> Character of soil to a depth of 3 feet: Sand Silt E) Clay 0 Peat 0 .Sandy Loam C]. Clay Loom <br /> Hardpan E) Adobe 'C] Fill Material ............ If yes,type .............:............... <br /> (Plot plan, showing size of lot, lo'cation.of-systein in relaition 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 I ) Size.___.--. . Liquid Depth .......................... <br /> ................................ <br /> V .,Capacity .................... .Type .................... Material---_---------------_- No. Compartments ..................... <br /> Distb'nce to nearest: W611.....................I.................Foundation ...................... Prop. Line ...................... <br /> d <br /> I 00 <br /> LEACHING LINE- No. of Lines ...........A'ength of each,line.................. ... Total' Length ............................ -A <br /> Box --------- Type Filter Filter Material. ........................... ............. <br /> Distance to nearest: Well .............-1: ......Foundation .--5...........:. Property Line ........ ............... <br /> SEEPAGE PIT Depth ..................... Diameter _________________Number .............. ...... ... Rock Filled Yes ❑ No C) <br /> Water Tdiii7be-pth ..................... ............•........Rock Size ................................ <br /> Distance to nearest: Well .............. ...................Foundation ................. Prop. Line ....... ........... <br /> REPAIR/ADDITION(Prev. Sanitation' Permit ................................ Dote ........... ...................... <br /> Septic Tank (Specify Requirements) ...................... ..........................................•--•••-©-•-- <br /> . ..........I...... <br /> ......**' <br /> Disposal Field-(Specify—Requirements) ......... . ....................... .................... <br /> "A <br /> . .. ..... <br /> ............ . ..... <br /> •---•-••---•----w•-...•-•-- ............. <br /> ------------- --------------------1­1------------------------------------------ -----------­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 Son Joaquin <br /> County Ordinances, State Laws, and Rules 'and Regulations of the San Joaquin Local Health District. Home owner or llcenw <br /> sed agents signature certifies the following:. <br /> ".1,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 beco e subioc, to Workman', C m- penscitildh1ows of California.'" <br /> Signed ..24__ .......... ....... ................. Owner. <br /> --- ----------- <br /> By ..... ........ -------- ....... . Title ...r...................................................... <br /> (Mother than ----------owner)- -----------*.. ..... ........................ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY............. .............................. ................ ...... ......................... DAVE.....-•/a. . . ........ <br /> BUILDING PERMIT ISSUED DATE ............. ..... <br /> ADDITIONAL COMMENTS ...... <br /> A <br /> . .......................................................................................�­............................................................................. .................... .............. <br /> ---•----------------...-..........-.._--------t....................... .................. .................................. --­----------------------- . .... ............. <br /> .................. .... ....................... ........1... .4 <br /> ........................ ..........—................. ......t..�...............I.............. ---- ate .... -.7...... <br /> -------------------- <br /> - -------- SAN JOAQUIN -LOCAL' HEALTH DISTRICT <br /> Final Inspecton by., <br /> 1-3 24 1-.'68 Rev. 5M. 7/72 PH ' <br />