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.Private <br />Clay Warn ' <br />i <br />_ <br />I <br />-4.7---- ---.- <br />APPLICATION FOR SANITATION PERMIT <br />, This Pemtit Expires 1 Year From Date Issued <br />_ ,_ , (Complete in Triplicate) <br />Permit No. 7c.... --7.7-r 1 <br />Date Issued 3 —/b .:7C <br />/ ,,,, -- 1 FOR OFFICE USE: <br />..- I I , t <br />Application Is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heririn ' , <br />described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: , <br />; <br />i <br />JOB ADDRESS/LOCAT1 N.?. .. ?7.-..9...). <br />' ... <br />. Rbi2 — ae.0--.----r---it:,) CENSUS TRACT <br />Owners Name ... ,,. Phone <br />i <br />: <br />Phone <br />, <br />^ • <br />Character of soil to a depth of 4 feet: Sand 0 1- Silt 0 Clay 0 Peat 0 Sany Loam 0 — -- <br />! ; <br />Hardpan' Adobe-0— Fill Milterial If yes; 4/130 <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 sellatic tank or seepage pit permitted if public sewer is available within 200 feet,) 1 <br />PACKAGE TREATMENT [ 3 SEPTIC TANK f ) .Liquid Depth <br />i Capacity . ' Type <br />A ,r Size <br />' Material No. Compartments <br />Distance to nearest: Well , Foundation Prop. Line <br />LEACHING LINE ( ) NO. of Lines , . ' Length of each fine Total Length , <br />I 'D', Box ' ' Type Filter Material Depth Filter Material <br />Distance to nearest: Well Foundation Property Line <br />F <br />SEEPAGE PIT [ 1 Depth ' Diameter Number Rock Filled Yes 0 <br />L . <br />Water Table Depth Rock Size <br />' Distance to nearest: Well <br />( . , Foundation <br />) <br />Prop. Line <br />r <br />REPAIR/ADDITION (Prey. Sanitation Permit # Date <br />i Septic Tank (Specify Requirements) <br /> <br />Disposal Field (Specify Requirements) aidee <br />Address ... ....1.1+.7.3 -49 <br />Contractor's Name _. J License # / , .3 2:--- <br />. <br />Installation will serve: , Resi ence Apartment House° Commercial 0Traller Court 0 , <br />Motel 0 Other • - <br />t —1 <br />i <br />. <br />' Number of living 'units: j Number of bedrooms 3----- Garbage Grinder tot Size <br />1 <br />Water Supply: Public System and name . <br /> t' 0 <br />1 '(Draw existing andreauired addition on reverie side) , , <br />I hereby certify that I have prepared this application and ,th at 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 />t <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 />a; to become sublect to Workman's Compensation laws of California." " 1 <br />r , <br />Signed ' Owner <br />By <br />/ <br />(If other than owner .t r <br />,. FOR liEl'ARTMENT USE ONLY <br />-Title CAP--7244-e-42`"1- <br />APPLICATION ACCEPTED i BY, C' iiIir J. DATE.] -:- I <br />, DATE BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS <br />. . . <br /> <br />Date 3- <br /> <br />Final Inspection by: <br /> <br />a 13 2)4 1-68 Rev. 5M AN JOAQUIN LOCAL HEALTH DISTRICT <br /> <br />8/74 3M <br /> <br />sZ,