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FOR OFFICE USE. FOR OFFICE USE: <br /> 40, - APPLICATION FOR SANITATION PERMIT <br /> ........-•--- ------------- -- ---- ---- <br /> ° (Complete in Triplicate) Permit No.-,r7-9---6-57 <br /> ............................ ............. .......... <br /> ^% Date I ssueclG.'�P7-?9 <br /> ........- ------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION - ley .. Ll.,w1, ... �V - . j teseA-.LENSUS TRACT------------------------- <br /> -----"- <br /> Owner's Name.__ ---- :.. . Phone.�� -Q. ...... <br /> Address 1. 1�....... � C '" + :.;... City-- ta-- ._Zip--- .. a �------- <br /> Contractor's Narrie. License -Phon <br /> # �. e" <br /> ... .................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> b Motel ❑ Other.".. ------ g �/ /� <br /> Number of living units:..............Number of bedrooms_... g nde-r i _:Lot Size..l�(9_X_ . 7f0! ----------- - --- <br /> .Garba e Gri ,�P� <br /> Water Supply: Public System and name_,.... .. tit <br /> :...... .............(/- - Private ❑ <br /> Character of soil to a de th of 3 feet: . Sand - ,ClayPeat.._. __Stand Loam - ClayLoam <br /> Hardpan Adobe Fill❑Material� ..lf yes, type..-' <br /> Y ❑ ❑ <br /> P ❑ Yf <br /> (Plot plan, showing size of lot, location of system,in.relation to wells, buildings -etc. must be placed on reverse side.) A <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] 'C I <br /> PACKAGE TREATMENT ( ] SEPTIC TANK ( ] Size.....`p yam.- Liquid Depth ::............. . . <br /> Capacity,�0"s�.--___.--Type -I Material.. GR-fk-- Compartments._-.. /. ._-..----." <br /> Type-IA <br /> ����// -- <br /> Distance'to nedresti Wetl�4W.4A t x'40 - <br /> �. Founddtion....�l�'­ IL .'::..Prop. Line... „ r <br /> i <br /> LEACHING LINE ( } No, of Lines _�_._.._.------------ Length of each lines'. --.......__-_Tota! Length ... _. ... .�-------------------- <br /> 'D' Box..€-... . Type Filter Materiae al...-. Iq---- ------ --------- - --- <br /> �� e th Filter <br /> to nearest: Wel , L - l� ounda#ion _ (�-... - roperty in .•.-- 'j '-------------- <br /> Distance, `-. <br /> SEEPAGE PIT ( ] Depth-.XS--,t Diametef...3. .........Number.._....♦�........_--------:7 Rock Filled Yes El No El <br /> r` � .a <br /> Water Table Depth-------��.....--•--------- ---------------------RockSize. - - 2.!1 A,&O�: - <br /> 4 <br /> Distance to nearest: Well. .---Foundation Pro <br /> ���� p. Line...'441 <br /> ... <br /> ar' F+r�w.rr • � � . � •..r ice` <br /> REPAIR/ADDITION {Prey. Sanitation Permit#---------- ---"- "-"""-_-------- -----.--=-.....Date"^.:--:------------'- - -.--------------------] `j <br /> Septic Tank {Specify Requiremenfs) ---- ----------- ------------ ----- ; <br /> ,.. - <br /> Y' y <br /> • ....................................... <br /> Disposal Field (Specify Requirements)--.----.---:.---------- ----...------ ------ -- - f <br /> v <br /> ...... ....... ... <br /> ........................................................... <br /> (Draw existing and required addition on reverse s_ide) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws,, and Rules and Regulations of .the,..Son Joaquin Local Wealth District, Home owner or licensed agents <br /> sigrinture certifies the following: <br /> "I certify that intheperformance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become subject to s Com tion Ea s of Califor Owner <br /> Signed_ _ -- ------- .. . <br /> Title-.. <br /> By-------------------- ------------------- ---------- -------=------------------------------ -------- <br /> (if <br /> ------(lf other than owner) ` "- <br /> POPDEPARTAMENI USE ONLY <br /> APPLICATION ACCEPTED BY.:. :. .,. ---...DATE ... -z7- <br /> --- " <br /> DIVISION OF LAND NUMBER.- - - ............................ ..--- --------- -------- -----.DATE.. --............. ...-- -._.......- <br /> ADDITIONAL COMMENTS ........... ............................... ---------- - ------------------- ----------- -- ................. - --------- <br /> --------------- --- -- ---- <br /> M,Qtn------- - -ll------------------- -------------------------------•-•---------------- --------....._.... <br /> Final Inspection b Date.---- - --- ---------- / <br /> EH 13 24 SAN JO/ +IN LOCAL HEALTH DISTRICT 8S 21677 RE <br /> V. 7/73fn .' <br /> f <br />