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<br />FOR OFFICE USE: <br /> <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br /> <br />This Permit Expires 1 Year From Date Issued <br /> <br />Permit No. <br />Date Issued <br />— CENSUS TRACT St I & <br />Phone - <br />Phone................ ...........- <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 />JOB ADDRESS/LOC N-Ar rt:Pely-- -ii <br />Owners Name <br />Address A 9e, /7 ,City <br />Contractor's Name s..License # <br />Installation will serve: Residence partment House° Commercial ['Trailer Court C] <br />Motel 0 Other <br />Number of living units. Number of bedrooms ‘72-: Garbage Grinder Lot Size <br />Water Supply: Public System and name • Private <br />Character of of soil to a depth of 3 feet: Sand '0 Silt 0 iClay 0 :Feat 0 Sandy Loam .r] Clay- Loam 0 <br />I • - Hardpan Adobe 0 'Fill Material If yes, type <br />(Plot plan, showing size of lot, location of system in Ir:elation to wells, buildings, etc. must be placed on reverse side.) ....- -•-, <br />I t i NEW INSTALLATION: 1 1(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br />PACKAGE TREATMENT [ ] SEPTIC TANK:[] Sie <br />Capacity . Type ! Material ...... ._._ .. ...... No. Compartments <br />,° — ! ' Liquid Depth <br />Distance to-nearest-Well i I Foundation Prop. Line <br />1". 1 , <br /> Length of each line Total Length <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, I shall not employ any person in such manner <br />as to become subject to Workman's Compensation laws of California." t," <br />(If other than owner) <br />FOR DEPARTMENT USE ONLY <br />0.1 P--Sr--%7 <br />BUILDING PERMIT ISSUED <br /> DATE <br />DATE <br />ADDITIONAL COMMENTS <br /> <br />Date e2 .1., 2 .. . . .........1 Final Inspection by: .... <br /> <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 1-68 Rev. 5M, <br />LEACHING LINE [ ] No. of Lines <br />'D'-.Box - Type Filter Material I Depth Filter Material 1 <br />Distance to nearest: Well Foundation Property Line , <br />SEEPAGE PIT [ ] Depth Diameter - Number Rock Filled Yes 0 No 0 <br />Water Table Depth l'tscick Size <br />Distance to nearest: Well Foundation Prop. Line <br />REPAIR/ADDITION (Prey. Sanitation Permit # Date I <br />Septic Tank (Specify Requirements) <br />Disposal Field (Specify Requirements) ..... .../4P.4'.__/_.eoZet-of „rie.-,--4.--e Ce / <br />- 33 " X -X-S-- 1 <br />Signed . <br />By <br /> Owner <br />Title <br />APPLICATION ACCEPTED BY ,/,:irt--e-grit <br />•